eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 60 April 7, 2009
















































Dreaded Mail: New Fee Schedules
Do you dread opening mail from payers these days? Fee schedule reductions may be on route to you today. If you are receiving a number of Notice of Fee Schedule Adjustment letters, we have some responses for you to use . . . . Read this article >>
AppealLettersOnline Featured Letters has two letters to assist with requesting fee schedule disclosure and initiating contract renegotiation. See the Topic Contract Negotiation for the Media Files titled:
  • Sample Letter for Requesting Managed Care Contract Renegotiation
  • Fee Schedule Renegotiation Request Letter
The following state-specific letters cite the advance notice requirements for fee schedule changes and would be useful for appealing fee schedule reductions which the carrier did not provide advance notice regarding:
  • California Fee Disclosure Law - requires 45 days advance notice of fee schedule changes (Updated)
  • Kentucky Fee Disclosure Law - requires 90 days advance notice of fee schedule changes (New)
  • Maryland Disclosure Law - requires 30 days advance notice of fee schedule changes
  • Ohio Fee Disclosure Law - requires 90 days advance notice of material fee schedule changes (New)
  • Texas Availability of Coding Guidelines - requires 90 days advance notice of fee schedule changes also has a number of new and updated state-specific appeal letters related to other topics as follows:
  • Colorado Disclosure Law (New)
  • Florida Refund/Recoupment Law (Updated)
  • Wisconsin Coding Law (New)
  • Wisconsin Grievance Review Requirements (New)
  • Wisconsin Preexisting Condition (Updated)
  • Wisconsin Utilization Review Requirements (New)
Access these letters >>
50 Appeal Letters & How To Use Them Like A Pro
Our most popular training course, 50 appeal letters & How To Use Them Like A Pro, is now available on CD. In this audio recording, Tammy Tipton, President of Appeal Solutions, discusses how to assert your rights when insurers deny or underpay. Level I and Level II appeal responses are discussed and legal protections related to appeal review will be explained. Some of the appeal letters to be discussed include the following:
  • Incorrect verification of benefits
  • 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.
50 Appeal Letters & How To Use Them Like A Pro also comes with a 30-day trial membership to  Orders received by April 30, will also receive a free copy of Appeal Solutions’ denial management book, Appeals Toolkit which includes comprehensive information on denial management and effective appeal tactics. Order the CD today.