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Appeal Letter Access: Easy, Easy at AppealLettersOnline.com Appeal letters are now easier to find and use. Most appeal letters require a very customized appeal. That is why AppealLettersOnline.com has more than 1600 letter options. However, frequent situations require medical billing professionals to appeal quickly with minimal denial detail. AppealLettersOnline.com introduces our Level I - Level II Basic Appeal Letters to address. . . .more >> Sub-Specialty Peer Review Of Denials: Some Insurers Find Sub-Specialty Peer Reviewers In Short Supply Access to sub-specialty peer reviewers is one of the most important protections related to quality appeal decisions. Yet recent insurance industry comments related to healthcare reform indicate that sub-specialty peer reviewers can be difficult to arrange within the appeal review time constraints and may result in review by a poorly qualified reviewer. . . .more >> Preauthorization Obtained But Not Honored: Utilization Review Standards Can Improve Preauthorization Appeals When medical preauthorization is not honored, it is often up to the billing professional to determine why. Where should you start? First, know the law. State utilization review laws vary considerably. Some states require carriers to. . . .more >> Preauthorization Process Improvement Tips That Work Does your practice have certain procedures, medical devices and/or medications which require extra preauthorization effort? If so, it is likely that your preauthorization requests process can be improved with detailed focus on. . . .more >> Using A Payer Appeal Form Do you have a love-hate relationship with forms?  Most insurance carriers have an appeal submission form to use when pursuing an appeal.  The carrier may even have separate forms for providers versus patient appeals, appeal versus grievance issues and plan-specific or state-specific forms to collect the appropriate data for the claim in question. . . .more >> Contesting A Carrier's Unreasonably Short Appeal Filing Deadline Healthcare appeal letter development involves time. For that reason, the National Association of Insurance Commission has recommended carriers provide at least six months for appeal filing. Read our article regarding a carrier's attempt to enforce a 45 appeal filing deadline and how bad appeal submission instructions from a carrier can set your efforts back. The article also quotes the ERISA claims procedure regulations which require most employer-sponsored group health benefits plans to provide a 180 days for appeal submission. . . .more >> Demanding HIPAA Compliance When Submitting Medical Records Repeated submissions of medical records to carriers is a frustrating, often unnecessary, burden on medical providers. Unfortunately, when carriers are unable to locate mailed medical records, medical providers have little recourse other than duplicating the time consuming process of copying, preparing and shipping an often voluminous file. From a practical standpoint, medical billing professionals will need to comply for requests for resubmission of lost documentation in order to get paid. However, providers may want to deal with "repeat offenders" by seeking. . . .more >> What's Covered and What's Not? Partner With Your Patients to Demand Transparency The latest AMA Insurer Report Card found that 19.3 percent of claims are paid incorrectly. Can you figure out which ones are which? Often, it takes too much time and too many demands to properly audit your payer’s claim adjudication. Let’s all say it together: Insurance payment terms are too complex. . . .more >>

Are Payer Requests for Supplemental Billing Detail Rising? Many healthcare organizations, particularly specialty and subspecialty providers, have identified a recent spike in requests for supplemental billing detail such as itemized statements. If the requests for information appear to far reaching, you may want to respond in writing with a request for clarification. Appeal Solutions has developed a sample letter for responding to overly broad requests for billing detail. . . .more >> Refund/Recoupment: Following The Money Settlement of a liability claim can take years and insurance carriers have a long memory. Unfortunately, providers get caught in the middle of the money muddle of who should pay and who should refund an overpayment. For this reason, providers need to review overpayment demands carefully. First, know how and if. . . .more >> The Changing of the Code: Quarterly Code Changes May Require Appeal Are your billing professionals keeping up with NCCI quarterly code changes? Now is the time to review the NCCI quarterly code change report. The NCCI code changes went into effect July 1 and include a number of retroactive code changes that allow you to resubmit claims for additional payment. . . .more >> Getting The Real Story On A Payer's Fee Schedule You have begged and pleaded and finally received the gold mine of information -- the payer fee schedule! But, do you have the whole story about how the payer will, or won't, pay? A complete fee schedule is more than just a list of the Current Procedural Terminology (CPT) codes and the associated contracted rate for your top procedures. In fact, it is quite possible that many of the contracted rates listed on the fee schedule would rarely be reimbursed at the listed value.  Why?  Because there are. . . .more >> 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. . . . more >> Using Disclosure Laws to Obtain Usual, Reasonable & Customary Denial Information UCR denials are often mired in mystery. What does usual, reasonable and customary mean? How are the reimbursement rates calculated? Are payers using governmental entitlement program benefits as a basis for calculating UCR? What proof has the payer collected that actually demonstrates that the denied claim has been billed at a rate above the norm. . . . more >> Denial Analysis Often Improves Healthcare Profitability What gets studied gets improved. This is one of the simplest management concepts yet one of the most challenging when it comes to ambiguous data. "What is understood gets improved" is the more accurate maxim for analyzing the ambiguous, often uncharted, sea of denial data being generated in the initial stages of healthcare denial management. Read this entire article for information on implementing effective denial analysis within your organization. . . . more >> The 60-Day Appeal Review Standard: Getting Carriers To Answer Appeals Appeal review deadlines vary from plan to plan and payer to payer. However, there are appeal deadlines applicable to most claims. We have developed appeal letters to assist you with citing the appeal review deadline applicable to many carriers. . . .more >>

  Displaying Matches 81 thru 96 of 123 Found.  BACK NEXT