September 8, 2010

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Timely Filing Appeal Improvement:  Customize Your Timely Filing Appeals For Appeal Success

Timely filing appeals are simple and straightforward.

In fact, the timely filing appeal letter is often merely a cover letter for timely filing documentation. A typical timely filing appeal briefly states that proof of timely filing information, such as patient account notes or electronic claim acknowledgement, is attached. Based on the documentation, payment is requested.

However, a successful appeal always covers all three steps to appeal success: a demand for denial disclosure, reference to compliance information such as claim processing laws or contractual obligations and, finally. . . .

Continue reading at AppealLettersOnline.com

Learn what the Patient Protection and Affordable Care Act (PPACA) interim rules can do to improve your profitability. . . . Upcoming Audioconference: 25 Proven Appeal Letters and Using PPACA For Today's Appeals.

AppealLettersOnline Featured Letters

We've added several appeal letters that can easily be customized for specialty-care specific appeals.  Please see the Topic: Specialty Care Appeal Review.  The following four letters have been added to AppealLettersOnline.com to assist with anesthesiology appeals:

  • Request for Clinical Criteria - Anesthesiology (new)
  • Request for Coding Criteria - Anesthesiology (new)
  • Request for Anesthesiology Peer Review (new)
  • Request for Coding Credentials - Anesthesiology (new)

These letters can easily be updated to reference a different sub-specialty care area.  For assistance with adapting these letters to other specialties or subspecialties, members can post their specialty billing questions in the forum area for their specialty.

Access these appeal letters at AppealLettersOnline.com

Fast Track To Appeal Success - Two Upcoming 90-Minute Appeals Training Audioconferences

"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.

We have two upcoming appeals audioconferences featuring our most successful appeal letters and how and why they work.

25 Proven Appeal Letters and Using PPACA For Today's Appeals - Presentation and Review of 25 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 as well as how PPACA will affect appeal review.

Date, Time and Cost:  Join us via audioconference on either October 12 or November 16 at 11 CST. Participation is $247.

"You have got to cite compliance information in appeals. When the law is in your favor, let carriers know. When the law demands disclosure of the denial information, peer review and external review, you shouldn’t have to ask twice," said Tipton, president of Appeal Solutions Inc. and author of several denial management products and publications.

PPACA, ERISA regulations and state laws contain a number of protections related to inappropriate delays and denials. Many medical providers do not understand how the PPACA, ERISA and state law work in conjunction to the benefit of both provider and patient. The upcoming audioconference will provide appeal instructions and 25 appeal letter templates covering the most common denial types such as incorrect payment, coding, medical necessity, maximum benefits, eligibility/coordination, timely filing and slow payment.

"Providers may mistakenly think their only protections are those spelled out in the managed care contract. Managed care contracts were written by the carriers. State and federal law go much further in demanding quality appeal review," said Tipton.

Sign up for the 90-minute audio presentation today. Find out more about this audio presentation.

Space is limited - Call 888-399-4925 today to register your staff to participate in this audioconference or order a CD Recording.

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