eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 48 February 12, 2008











Whos Reviewing Your Appeals? Man or Machine?
Appeals involve highly technical issues such as clinical guidelines, specialty coding standards, quality of care and contract requirements. Computers are not good at appeal review. This article discusses how to ensure you receive quality appeal reviews by a qualified, credentialed reviewer.
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AppealLettersOnline Featured Letter has a new letter to assist subscribers with seeking appeal review by a credentialed medical reviewer and/or active practice health professional. See the new letter entitled "Request for Review By Qualified Reviewer" under the Appeals Repository Topic, "Medical Necessity" and the subcategory, "State Medical Necessity Terms." Also under this category, see the range of state-specific letters which will assist subscribers in citing state, ERISA and Medicare requirements regarding appeal reviewers qualifications.
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50 Appeal Letters & How To Use Them Like a Pro: Appeal Solutions will present 50 Level I and Level II Appeal Letters on March 4. Tammy Tipton, President of Appeal Solutions and author of HCPros "Appeals Toolkit," will discuss how to assert your rights when insurers deny or underpay your claims.  The 90-minute presentation will focus on assessing Level I appeal responses and how to respond to poor appeal reviews with effective Level II appeal letters.  The presentation also includes:

  • Lack of timely filing appeals and using affidavits for establish timely filing.
  • Selecting the most appropriate letter for each appeal and determining which state and/or federal laws to know and use for each type of appeal.
  • Coding appeals and demanding a review by a certified coder.
  • Seven tips to improve medical necessity denials with the help of our Level I and II Medical Necessity Appeal Letters.
  • Getting a move on stalled claims by citing regulatory information.
  • Maximum Benefit Appeals and How To Respond.
  • Refund/Recoupment Response letters.

A sample appeal letter is available. Click here for more info or to sign up.