May 5, 2015

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Unexplained Payment Variances: To Ignore or Appeal?

Medical claim payment variances come in all sizes and shapes. Some payment variance is justified and can be tracked down to modifiers, scheduled contract adjustments or newly-implemented coding guidance. However, some payment variances are more suspect. Some discounts are related to incorrect modifier application and/or usual, customary and reasonable adjustments should be scrutinized for accuracy.

The trouble is in knowing what to appeal and what to accept as a correct adjustment. Once a payment variance is identified and the adjustment does not appear to be supported, action should be taken to determine if the payment adjustment is accurate.  Here are some steps to consider when assessing payment variances . . . .

Keep reading this article.

AppealLettersOnline.com New Content

We have new appeal letters for the State of New York. New York recently enacted several protections related to out-of-network benefit calculations. See the following letters related to this new law under the Topic: Benefit Calculations

  • New York Non-participating Payment

  • New York Non-Participating Emergency Care Reimbursement

Contact Tammy Tipton at t.tipton@appealsolutions.com to schedule a customized ICD-10 denial management webinar for your staff covering denial avoidance and effective appeals.

Access the appeal letters at AppealLettersOnline.com

Free Webinar: Strategies for ICD-10 Appeal Success

Is your appeal process ready to handle the higher denial rates predicted to accompany ICD-10?  According to CMS, in the early stages of ICD-10 implementation, denial rates could increase by 100 to 200 percent.

Learn how to make your appeal process ICD-10 ready by attending a free webinar sponsored by Navicure on Tuesday, June 16 at 1 p.m. EDT/10 am PDT: Strategies for ICD-10 Appeal Success.

During this hour, you'll hear industry expert Tammy Tipton discuss:

  • Training your staff to be the front line in ICD-10 denial avoidance

  • Tips to improving your practice's denial review process and why to reconsider the financial threshold for appeal escalation

  • What specific demand to make in an ICD-10 appeal so that your appeal gets a high quality review by a qualified reviewer

  • Best practice for Level II appeal letters and why persistence pays in the appeals process

Watch the the Navicure events page for the registration link which will be available later this month - http://www.navicure.com/cp-events.htm.  Participants can earn 1.0 Continuing Education Unit (CEU) from the AAPC by attending the live webinar.  Don't let ICD-10 denials become a revenue drain.  Know what steps to take to ensure you maximize your reimbursement.

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