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ERA Transparency & Denials:  How Medicaid Remittances May Clog Up The Workflow

Not every medical claim sails through the payer adjudication process.  Every healthcare billing professional knows that some claims get dumped right back in your lap for "resubmission."

Here's the tough question: How many hours does your staff spend on resubmission?

And the other critical follow-up question: How much do you collect on resubmitted claims?

The answer depends a lot on each payer's communication or lack of it . . .

Continue reading this article at AppealLettersOnline.com

AppealLettersOnline.com Featured Letter

See our new letter citing the Medicaid timely payment requirements and seeking payer compliance to the prompt payment requirements.  See the Topic: Stalled Claims and the Subtopic: Medicare/Medicaid for the new letter "Medicaid Prompt Payment."

AppealLettersOnline.com has new information on managed care negotiations under the Topic Contract Negotiation.  See this area for the most commonly overlooked managed care contract protections as well as suggested contract wording.  There are a number of helpful documents under Contract Negotiation including the following:

Access the appeal letters at AppealLettersOnline.com

25 Medical Necessity Letters and How to Use Them Like a Pro

Appeal Solutions has developed the largest collection of medical necessity appeal letters available.  These letters are most effective when used by a billing team trained on demanding quality appeal review from payers.

25 Medical Necessity Letters & How to Use Them Like A Pro is a three hour presentation which is customized for your practice.  Tammy Tipton, President of Appeal Solutions, will discuss how to assert your rights when insurers use medical necessity to deny standard of care medical treatment.  Level I and Level II appeal responses will be discussed and legal protections related to appeal review will be explained.  Some of the appeal letters to be discussed include the following:

• Inadequate Peer Review Availability

• State and/or federal laws related to utilization review including access to care, peer review and compliance with prompt decision making requirements.

• Demanding release of written clinical guidelines and making the argument against overly restrictive criteria

• External review and what it can do for you and your patients.

• Patient Appeal Efforts.

Training includes 25 appeal letters customized for your specific state requirements and specialty review needs.  Call for a customized quote for your organization or professional networking group.

Visit AppealSolutions.com for more information or call 888-399-4925.