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How Will External Review Expansion Affect You?  External Review Under PPACA

Healthcare reform will make seeking external review of denied claims more accessible.  The big question remains, "Will external review play a role in improving quality?"

The Patient Protection and Affordable Care Act (ACA) protection of external appeal rights is aimed at reducing the troublesome concerns of conflict of interest in medical decision making. The interim final regulations on appeals released in July outlines expansive new external review requirements. . . .

Continue reading this article at AppealLettersOnline.com

Learn what the Patient Protection and Affordable Care Act (PPACA) interim rules can do to improve your profitability. . . . Upcoming Audioconference: 25 Proven Appeal Letters and Using PPACA For Today's Appeals.

AppealLettersOnline Featured Letters

Appeal Solutions has added a new letter to seek clarification regarding PPACA compliance with external review law.  Please see the following new letter:

• Request for External Review Information (New)

We also have a number of state-specific appeal letters which cite each state’s external review requirements.  Subscribe to AppealLettersOnline.com for instant access to the following:

• Idaho External Review Appeal (New)
• Kentucky Grievance Review (New)
• North Carolina External Review Appeal (New)
• Wyoming External Review Appeal (New)
• Wyoming Medical Necessity Appeal (New)

State Specific letters have also been updated for the following states:  Illinois, Kentucky, Idaho, Mississippi, North Carolina, Wisconsin.

Access these appeal letters at AppealLettersOnline.com

Fast Track To Appeal Success - Upcoming 90-Minute Appeals Training Audioconference

"Denial upheld. There is no new information in your appeal."

This is an all-to-frequent response to most medical claim appeals but it doesn’t have to be the final word.

We have two upcoming appeals audioconferences featuring our most successful appeal letters and how and why they work.

25 Proven Appeal Letters and Using PPACA For Today's Appeals - Presentation and Review of 25 Level I and Level II Appeal Letters which are designed to easily appeal all denials and demand a detailed response from insurers regarding nonpayment. Proven Strategies for Level II appeal customizations, denial prevention and what to do when appeal efforts fail will also be discussed as well as how PPACA will affect appeal review.

Date, Time and Cost:  Join us via audioconference on November 16 at 11 CST. Participation is $247.

"You have got to cite compliance information in appeals. When the law is in your favor, let carriers know. When the law demands disclosure of the denial information, peer review and external review, you shouldn’t have to ask twice," said Tipton, president of Appeal Solutions Inc. and author of several denial management products and publications.

PPACA, ERISA regulations and state laws contain a number of protections related to inappropriate delays and denials. Many medical providers do not understand how the PPACA, ERISA and state law work in conjunction to the benefit of both provider and patient. The upcoming audioconference will provide appeal instructions and 25 appeal letter templates covering the most common denial types such as incorrect payment, coding, medical necessity, maximum benefits, eligibility/coordination, timely filing and slow payment.

"Providers may mistakenly think their only protections are those spelled out in the managed care contract. Managed care contracts were written by the carriers. State and federal law go much further in demanding quality appeal review," said Tipton.

Sign up for the 90-minute audio presentation today. Find out more about this audio presentation.

Space is limited - Call 888-399-4925 today to register your staff to participate in this audioconference or order a CD Recording.

AppealLettersOnline.com Podcast Library Coming in 2011!

AppealLettersOnline.com has a unique opportunity for healthcare experts.  We are seeking legal and revenue cycle experts interested in being featured in our Podcast Library to be introduced next year.

Participation is easy and cost free.  It allows you to talk directly with our healthcare clients about your area of expertise.  We will interview experts regarding a number of hot topics.  The interview will be via phone and then podcast to more than 10,000 AppealLettersOnline.com monthly visitors.  The healthcare industry does their homework and they do their homework at AppealLettersOnline.com.

If interested, email Tammy Tipton at t.tipton@appealsolutions.com with your suggested Podcast content.