eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 51 May 13, 2008





















Specialty-Specific Appeals: Demanding A Quality Review of Specialty Care Claims
Specialty care medical appeals often involve complex clinical information. Hours can be spent crafting a detailed explanation regarding the treatment provided and current specialty care standards. We have developed a number of "appeal review demands" which are particularly applicable in overturning specialty care denials. Read this entire article...
AppealLettersOnline Featured Letters
Appeal Solutions has a number of appeal letters which can be easily customized for such specialty-care appeals. Please see the Topic: Specialty Care Appeal Review.  The following four letters have been added to AppealLettersOnline to assist with obstetrical-gynecological appeals:

1. Request for Clinical Criteria - Ob-Gyn
2. Request for Coding Criteria – Ob-Gyn
3. Request for Ob-Gyn Peer Review
4. Request for Coding Credentials – Ob-Gyn

These letters can easily be updated to reference a different specialty care area.  For assistance with adapting these letters to other specialties,  members can post their specialty billing question in the forum area for their specialty.

Sign up to access these letters
Specialty Care Appeals Training
We provide several customized specialty appeals training programs. Training involves a four-hour presentation to your billing group on avoiding denials by demanding specialty peer review and how to appeal denials by demanding a quality specialty care appeal review.

Special pricing is currently available for our orthopedic and chiropractic specialty care training programs. The cost of the training includes customized appeal letters for your organization which specifically addresses the most frequently denied claims for your specialty. Training also addresses stalled claims and responding to carrier stalls and delays.

Each training provides extensive information on state utilization review laws and how they apply to verification and precertification requests and related appeals.  ERISA protections related to employee benefit plans and claim processing protections which apply to specialty care claims are also discussed. Participants may submit representative denials prior to the training so that the presentation includes analysis of your organization’s recent problematic denials.

Cost of the presentation is a flat rate of $4,000, inclusive of all travel expenses.  However, orthopedic and chiropractic organizations which book training for June or July qualify for a discounted rate of $3,200.  Contact Tammy Tipton at 888-399-4925 or for information and to receive a list of customized appeal letters which have been included in recent orthopedic and/or chiropractic appeal presentations.