eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 57 Jan 14, 2009





























Appealing Observation Level of Care Denials
Many organizations are seeking ways to expand their observation care units to include more specialized personnel and equipment and intensive patient education programs. This month's featured article is a round-up of online articles related to effective observational care reimbursement. . . . Read this article >>
AppealLettersOnline Featured Resources has five new letters for appealing observational care. The following letters are available at under Topic: Specialty Care.
  • Request for Clinical Criteria for Observation
  • Request for Coding Criteria - Observation
  • Cardiology Peer Review for Chest Pain
  • Neurology Peer Review of Headache
  • Pulmonary Peer Review of Asthma
Access these letters >>
Onsite Appeals and Denial Avoidance Training Customized to Your Needs.
We've developed an onsite appeal training program for organizations which plan to take control of denial management in 2009. Tammy Tipton, President of Appeal Solutions and author of HCPro’s “Appeals Toolkit,” has developed a comprehensive training program designed to assist medical providers with appeals, prior authorization techniques and contract negotiation. This program involves a four hour customized presentation which addresses the client’s most frequent denials. Presentation includes:
  • How to utilize state and federal consumer protections mandates to demand prompt payment, interest penalties on late payment and prompt, detailed appeal responses.
  • How to win medical necessity appeals by demanding peer-to-peer reviews, clinical review criteria and external review of denied claims.
  • How to use the state verification/utilization review laws to obtain accurate, uncontestable verifications prior to treatment
  • How to negotiate with carriers who do not follow state and federal laws regarding claims processing and utilization review.

Most importantly, this training opportunity is customized to fit your specific denied medical claims and presented to your staff at your office.  Prior to the presentation, medical providers may submit 10 representative denials to Appeal Solutions for analysis.  Ms. Tipton will develop and explain customized strategies to address both avoiding and appealing the denials specific to your organization.  The onsite training session allows your entire staff to receive in-depth training focused on your organization’s unique challenges.

Now is the time to secure this valuable staff training opportunity for your staff.  The presentation is priced at only $2500 plus travel expenses.  As a special bonus, those who schedule training anytime during the first quarter of 2009 will receive a complimentary copy of HCPro’s Appeals Toolkit (regularly $199).