eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 67 April 15, 2010

















Appealing The Dual Diagnoses Dilemma
If patients suffered one illness or injury at a time, healthcare would be simplified. Most patients present a more complicated mix with multiple medical issues requiring treatment. Yet, carrier clinical review criteria and guidelines do not readily account for multiple diagnoses patients. . . . . Read this article >>
AppealLettersOnline Featured Letters
Appeal Solutions added a number of letters for appealing oncology denials. Please see the following letters under the topic Specialty Care:

  • Request for Clinical Criteria – Oncology
  • Request for Coding Credentials – Oncology
  • Request for Coding Criteria – Oncology
  • Request for Oncology Peer Review
  • Request for Peer Review – Oncology Surgery Assistant
Access these letters >>
50 Texas Appeal Letters & How To Use Them Like A Pro
Appeal Solutions has developed an appeals training program specifically for Texas medical billers. 50 Texas Appeals Letters & How to Use Them Like A Pro is a three hour presentation specific to Texas insurance claim review laws. Tammy Tipton, President of Appeal Solutions, will discuss how to assert your rights when insurers deny or underpay medical 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 specialty care including access to care, peer review, direct access and clinical trial coverage and how to demand compliance with mandatory coverage laws.
  • Coding appeals and demanding a review by a specialty coder and release of coding criteria.
  • Getting action on unnecessarily stalled claims and incorrect payment including UCR, Silent PPO and contractual denials
  • Seven tips to improve medical necessity denials
  • Maximum Benefit Appeals and
  • How To Respond to Refund/Recoupment Response letters.

Cost of the presentation is $3,000 plus hotel and transportation expenses for your area. Training includes 50 appeal letters customized for the client’s specific denial issues.