Sept 15, 2016

Getting Some Legal With Your Medical Review

Indications That Independent Reviews Are Looking Into Clinical and Legal Issues

As medical care and reimbursement rules grow more complex, so does submitting effective appeals. You really need a doctor-lawyer conducting your appeals.

But even if you did, does that guarantee that your clinical and legal points would be given full consideration? The wide array of professionals currently involved in appeals – from doctors to medical billing professionals – have often complained that payers give scant attention to clinical arguments and almost none to legal arguments. . . . . Keep reading this article. New Letter Content

The appeal letter collection has updated Pediatric-Specific Appeal Letters. Be sure to download and distribute this information to your impacted staff so that this information can be incorporated into your daily processes:

  • Immunizations Appeal Level I
  • Immunizations Appeal Level II
  • Newborn Hearing Screening Appeal

Access these resources and many more at

Live Webinar: Gold Medal Appeals

Creating appeals isn’t an Olympic sport, but it does require practice and training if you want to win them. New payer medical necessity and coding guidance are making it even more challenging to do so. To be successful, organizations must know their rights to a full and fair appeal review and hold payers accountable for decisions which impact care - and revenue.

Learn the winning appeal formula by attending a complimentary webinar on Wednesday, September 14th at 1 pm EDT/10 am PDT: Gold-Medal Appeals.

During this one-hour webinar sponsored by Navicure®, you’ll hear industry expert Tammy Tipton, president of Appeal Solutions, discuss:

  • Appeal basics which every appeal letter should cover - clinical and/or coding information, payer guidance or legal protections, and documentation
  • Successful strategies for avoiding "no new information" denials and elevating your appeal review to the highest review levels
  • Value-based reimbursement’s (VBR) critical impact on appeal success and how to prepare for future VBR-related denials

Participants can earn 1.0 Continuing Education Unit (CEU) from the AAPC by attending the live webinar.* Register at

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