eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 68 June 8, 2010


















Medicare Timely Filing
The newly enacted Patient Protection and Affordable Care Act amends the timely fling requirements on Medicare Fee for Service claims to one calendar year after the date of service. Learn more about how this will affect your facility. . . . Read this article >>
AppealLettersOnline Featured Letters
We've added a new letter citing the Patient Protection and Affordable Care timely filing requirements. These letters can be used in situations where the carrier has not allowed the federally mandated time frame for filing claims. Please see the following letter under the topic Timely Filing: Notice of Original File Date – Medicare Fee For Service.

We've also updated the following state-specific letters to reflect legislative changes:

  • South Carolina Prompt Payment Statute
  • South Carolina Interest Statute (new letter!)
  • South Carolina Overpayment Law (new letter!)
Access these letters >>
Appeals Audioconference provide Fast Track to Appeal Success
"Denial upheld. There is no new information in your appeal." This is an all-to-frequent response to most medical claim appeals but it doesn’t have to be the final word. Appeal Solutions has a number of recorded appeals audioconferences which feature our most successful appeal letters. Visit our website for a complete list of available Audioconference Recordings including the following:

50 Appeal Letters & How To Use Them Like a Pro – Content: Presentation and Review of 50 Level I and Level II Appeal Letters which are designed to easily appeal all denials and demand a detailed response from insurers regarding nonpayment. Proven Strategies for Level II appeal customizations, denial prevention and what to do when appeal efforts fail will also be discussed. Learn more about our Recorded Audio Conferences.

Medical Necessity Appeals and Demanding A Quality Review By the Payer Content: Presentation and Review of 20 Level I and Level II Appeal Letters specifically addressing medical necessity denials. Presentation will include how to assess appeal responses for signs of a poor quality review. Strategies for demanding peer review, peer discussion, expert review and complete clinical disclosure will be explained. Level II medical necessity appeal customizations will be demonstrated so that none of your higher level appeals are rejected due to "no new information." Learn more about our Recorded Audio Conferences.