Sept 2, 2014

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Get Attached To Appeal Attachments:  5 Powerful Attachments To Improve Your Appeal Letters

Yes, your appeal letter may be highly persuasive.  You may feel victory is at hand!  However, pause one moment before sending the appeal letter and consider the fact that almost every appeal letter can be improved with a related attachment.

Attachments are often the "proof" that the insurance reviewer needs in order to overturn a denial.  Also, attachment can affect the review costs and time burden on the insurance carrier. Your attachment, not the appeal letter content, may be the driving factor in whether the appeal is processed by internally or submitted to a outside consultant with expertise in the area in question.

Medical records are the most common appeal letter attachment.  A summary of the clinical justification for treatment should appear within the body of the letter but is typically not sufficient documentation for the insurance carrier.  The medical records' history and physical is also a good source of information on what other providers might have pertinent information regarding past treatment and the patient's treatment resistance.  This information may also be highlighted and a recommendation included in the appeal letters to obtain this additional information before rendering an adverse determination.

As follows are five other potential attachments which can make the winning difference in your appeal efforts:

Keep reading to see the 5 powerful attachments to improve your appeal letters

AppealLettersOnline.com Featured Letters

Insurance benefits have been significantly impacted by the Affordable Care Act's Essential Health Benefits (EHB) requirements. The ten categories of essential benefits include some of the more frequently denied areas of coverage, such as emergency services, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services and preventative and wellness services. Although coverage for these types of services may have expanded, medical necessity scrutiny is likely on the rise given carrier concern related to the financial impact of coverage expansion.  AppealLettersOnline.com has medical necessity appeal letters related to these specialty care areas under the Specialty Care category of letters.  If you have an EHB appeal and do not see an appropriate letter, email us at t.tipton@appealsolutions.com.

Access the appeal letters at AppealLettersOnline.com

Get Your Practice Ready For ICD-10

Learn how to get ready for ICD-10 Denial Management by securing Appeal Solutions to present at your next MGMA, AAPC or HFMA conference.

Tammy Tipton, President of Appeal Solutions, explains how to track hidden denials for optimum financial performance.  Providers must clean up accounts receivables now and also focus on poor payer claim processing performance.  ICD-10 presentations cover the following denial management appeal best practices critical to reimbursement security in the coming months:

  • Tactics to better identify "hidden denials" and tips to better track them in order to improve your ICD-10 readiness.
  • What types of denials will likely be impacted by ICD-10 implementation and how to prepare an optimum ICD-10 denial management strategy.
  • Best practices for writing appeal letters, including how to demand disclosure of ICD-10 claim decisions and what to do about uncooperative payers.

Contact Tammy Tipton at t.tipton@appealsolutions.com if your chapter is looking for an educational presentation specifically designed to empower providers to protect reimbursement during the ICD-10 implementation.  Tipton will also customize a presentation to a specific organization's needs and work with your ICD-10 implementation team to improve denial management in conjunctions with ICD-10 implementation.

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