eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 64 Jan 12, 2010




















Stopping Silent PPO Discounting: State Laws Recognize Silent PPO Unfairness
A number of state laws now set limits on Silent PPOs and seek to protect providers from unfair and un-negotiated preferred provider discounting. . . . Read this article >>
AppealLettersOnline Featured Letters
Appeal Solutions added a number of letters for appealing Silent PPO reductions. Please see the following letters under Benefit Reductions in the Repository:
  • Arkansas Contract Leasing Disclosure
  • California Contract Leasing Disclosure
  • Connecticut Physician Discount Disclosure
  • Florida Contract Leasing Disclosure
  • Kentucky Discount Disclosure
  • North Carolina Discount Disclosure
  • Ohio Contract Leasing Law
  • Oklahoma Contract Leasing Law
  • Texas Contract Leasing Law
Access these letters >>
50 Florida Appeal Letters & How To Use Them Like A Pro
Appeal Solutions has developed an appeals training program specifically for Florida medical billers. 50 Florida Appeals Letters & How to Use Them Like A Pro is a three hour presentation specific to Florida insurance claim review laws. 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 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
Cost of the presentation is $2500 plus airfare, hotel and transportation expenses for your area. Training includes 50 appeal letters customized for your specific denial issues. This presentation is only available until March 5 so contact us immediately to schedule the presentation for your organization.