eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 58 Feb 11, 2009

























Now is the Time to Expand Your Verification of Benefits Form
Now is a good time to make sure your medical organization’s verification process is sufficiently thorough to identify the effects of pay-the-patient initiatives, high deductibles and tighter utilization review controls. . . . Read this article >>
AppealLettersOnline Featured Letters has a number of appeal letters specifically designed for assisting with appeals related to incorrect verification of benefits. See Benefit Disclosure at the website for information.  New appeal letters to address orthopedic appeals have been added. See the following new letters under Specialty Care:
  • Request for Clinical Criteria – Orthopedic
  • Request for Coding Credentials – Orthopedic
  • Request for Coding Criteria – Orthopedic
  • Request for Orthopedic Peer Review
We have also added a number of state-specific appeal letters for the states of Georgia and Kansas, including the following appeal letters:
  • Georgia Access Law
  • Georgia Authorization law
  • Kansas Overpayment Law
  • Kansas Utilization Review Law
  • Kansas Request for Specialty Review
  • Kansas Request for Clinical Criteria
Access these letters >>
50 Appeal Letters & How To Use Them Like A Pro
Appeal Solutions will present 50 appeal letters and discuss using them most effectively in an appeals audio conference set for March 10. Tammy Tipton, President of Appeal Solutions, will discuss how to assert your rights when insurers deny or underpay.  Level I and Level II appeal responses will be discussed and legal protections related to appeal review will be explained including:
  • Utilization Review and demanding prompt response, peer review and release of clinical criteria to support denials.
  • State and/or federal laws related to specialty care including access to care, peer review, anti-discrimination, direct access and clinical trial coverage and how to demand compliance with mandatory coverage laws.
  • Coding appeals and demanding a review by a specialty care coder and release of coding criteria.
  • Seven tips to improve medical necessity denials.
  • Getting action on unnecessarily stalled claims.
  • Maximum Benefit Appeals and
  • How To Respond to Refund/Recoupment Response letters.

Sign up for the 90-minute audio presentation today. Find out more about this audio presentation.