Five Sentences to Improve Your Appeal
Do your carefully worded appeals result in simple form letter responses?
If so, it is likely that your appeals may need more forceful language regarding carrier appeal review and response requirements.
our 5 sentences that will improve your appeal letters.
AppealLettersOnline Featured Letters
We have a number of new appeal letters that 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 - Neurology
2. Request for Coding Criteria – Neurology
3. Request for Neurology Peer Review
4. Request for Coding Credentials – Neurology
These letters can easily be updated to reference a different specialty care area. For assistance with adapting these letters to other specialties, AppealLettersOnline.com members should post their specialty billing question in the forum area specific for their specialty.
Access these letters
Medical Necessity Appeals
Our Audioconference, Medical Necessity Appeals and Demanding A Quality Review by the Payer, discusses your rights in regard to demanding a quality medical necessity appeal review. This 90-minute audioconference
will be Thursday, October 2, at 11 a.m. CT. Cost is $249.00 and includes 15 sample medical
necessity and experimental/investigational appeal letters.
Medical necessity appeals involve detailed discussions of a
patient’s unique medical condition and how the
specialty-specific treatment provided is the most
appropriate, medically necessary option. Such appeals can
take hours to properly develop. However, what assurance does
a provider have that appeals reviewers will thoroughly
review this detailed, patient specific, specialty-care
information? We will provide 15 medical necessity and
experimental/investigational appeal letters which focus on
demanding the highest quality medical review at the
insurance carrier. During the presentation, we will discuss
how to demand that the appeal reviewer has appropriate
credentials for the review. Medical necessity appeals rely
on clinical issues and we will also discuss how to demand
detailed review of the submitted medical documentation and
how to seek review of any submitted peer-reviewed literature
supporting treatment. We will discuss the provider’s rights
to the insurance carrier’s internal clinical criteria,
expert opinions and technical assessments and how to use and
critique the applicability of such information in Level II
appeals. Finally, we will look at insurance litigation which
has criticized carrier review for failure to thoroughly
review submitted information and discuss how to cite the
carrier’s legal obligations in your appeals.
Signup for this audioconference.