eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 62 Aug 10, 2009




















Demanding Peer Review of Pediatric Denials
Pediatric care often involves aggressive medicine. Pediatric care givers are well known for their tenacity in providing their young patients with the future they deserve. Diagnostic medicine, too, is often made more complex with pediatric patients. The demands of pediatric care often are at odds with the constraints of black and white coverage terms. . . . Read this article >>
AppealLettersOnline Featured Letters
Appeal Solutions added a number of letters for appealing denials related to pediatric claim review. Please see the following letters under the topic Specialty Care:
  • Assistant Surgeon - Pediatric
  • Request for Clinical Criteria – Pediatric
  • Request for Coding Credentials – Pediatric
  • Request for Pediatric Peer Review
Access these letters >>
50 Pediatric Appeal Letters & How To Use Them Like A Pro
Appeal Solutions has developed an appeals training program specifically for pediatric billers. 50 Pediatric Appeals Letters & How to Use Them Like A Pro is a three hour presentation specific to pediatric appeals. Tammy Tipton, President of Appeal Solutions, will discuss how to assert your rights when insurers deny or underpay pediatric claims. Level I and Level II appeal responses will be 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 pediatric care including access to care, peer review, newborn coverage requirements, direct access and clinical trial coverage and how to demand compliance with mandatory coverage laws
  • Coding appeals and demanding a review by a pediatric 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
Cost of the presentation is $2500 plus airfare, hotel and transportation expenses for your area. Training includes 50 appeal letters customized for the client’s specific denial issues. This presentation is available until Sept 30 so call immediately to schedule the presentation for your organization.