eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 52 June 17, 2008






















Submitting Peer-Reviewed Literature with Medical Necessity Appeals: My Evidence vs. Your Evidence

Submission of peer-reviewed literature can strengthen medical necessity and experimental/investigational appeals. Insurance companies have a duty to review information submitted during an appeal. Furthermore, an insurance company’s failure to properly review the clinical information can jeopardize their ability to legally defend their denial decision. Read this entire article...
AppealLettersOnline Featured Letters
We have a number of new appeal letters which can be easily customized for specialty-care appeals.  Please see the Topic: Specialty Care Appeal Review. The following four letters have been added to AppealLettersOnline to assist with cardiology appeals:

1. Request for Clinical Criteria - Cardiology
2. Request for Coding Criteria - Cardiology
3. Request for Cardiology Peer Review
4. Request for Coding Credentials - Cardiology

These letters can easily be updated to reference a different specialty care area.  For assistance with adapting these letters to other specialties, members should post their specialty billing question in the forum area specific for their specialty.
Sign up to access these letters
Free Book With Purchase! Appeals Toolkit Packed with Extensive Information On Overturning Denials
HCPro’s Appeals Toolkit, a comprehensive resource for appealing denied claims, is included with any online purchase placed by June 30.

This Appeals Toolkit contains extensive information on providers’ legal rights regarding appeal review and how to strengthen appeal letters with persuasive legal information.  25 tested, proven, and effective sample appeal letters are included in the book to demonstrate using legal citations in appeals.

Medical billing professionals will find extensive information on successfully overturning claims. Further, verification and case management staff will find extensive information for avoiding denials and how to contest incorrect verification/authorizations and how to contest poor quality medical necessity review.

Chapters are devoted to health benefit plan appeals (ERISA) and Medicare appeals.  Level II appeal tactics are also discussed so that medical billing professionals can easily continue appeals to higher levels of review.

To receive a free copy of Appeals Toolkit, place an order at for any product – membership, Audioconference CD or Power of Appeals.  Enter coupon code BOOK on the online order form. Appeals Toolkit will be immediately shipped to the contact person and address on the order form.