eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 59 March 3, 2009
















Demanding Peer Review of Assistant Surgeon Denials
"The decision to request that a physician assist at surgery remains the responsibility of the primary surgeon and, when necessary, should be a payable service.  This familiar statement is part of the ACS Physicians as Assistants at Surgery 2007 Study, which is widely used to determine insurance coverage for assistant surgeons and other surgical assisting fees. Unfortunately, appeals are often necessity to address the medical necessity of surgical assistants. . . . Read this article >>
AppealLettersOnline Featured Letters has a number of appeal letters for appealing denials related to surgical assisting.  Please see the following letters under the topic Specialty Care:
  • Assistant Surgeon - Cardiology
  • Assistant Surgeon Neurology
  • Assistant Surgeon Ob-Gyn
  • Assistant Surgeon Orthopedic
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.