March 6, 2013

Greetings {ContactName|Appeal Letter Subscriber},

ICD-10 and Your Management Care Contract: Hold Harmless or Hold Accountable?

Your ICD-10 preparation checklist seems to be growing, right?

Now, stories are beginning to surface that some healthcare organizations are being asked to sign off on hold harmless terms related to the upcoming coding overhaul. . . .

Continue reading this article at AppealLettersOnline.com

AppealLettersOnline.com Featured Letters

We've added a number of letters for appealing dermatology denials.  Please see the following letters under the topic Specialty Care:

  • Request for Clinical Criteria - Dermatology (New)

  • Request for Coding Credentials - Dermatology (New)

  • Request for Dermatology Peer Review (New)

  • Request for Coding Criteria - Dermatology (New)

Access the appeal letters at AppealLettersOnline.com


It's About Time:  Why Most Denials Are Never Appealed

Have you clocked how long it takes to write a winning appeal letter?

Many denials are never appealed. Why? Simple math.  It takes too much time to write a good appeal letter and, due to this investment, the payoff can be poor.  Therefore, performance improvement and efficiency tools such as our Power of Appeals software are critical to denial management success.

If you are looking for a time saving tool, we've already written effective appeal letters for every denial scenario.  You can select a letter in minutes, get it in the mail and sit back and let the carrier do the work of providing a detailed explanation by a highly qualified reviewer.  In fact, our letters make specific demands meant to insure a quality review of the denial.

AppealLettersOnline.com features more than 1600 effective appeal letters.  These letters cover every denial category including medical necessity, timely filing, bundling, eligibility, lack of preauthorization and incorrect benefit calculation.  However, one common aspect of these letters is a well-worded demand for Payer Compliance.

Yes, payers have specific legal obligations for processing appeals in a timely, professional manner.  Further, if the appeal makes a request for disclosure of information related to the claim, such as clinical criteria or credentials of the reviewer, the payer must review this disclosure demand carefully and respond in accordance with consumer protection laws which require transparency in adverse decisions.

However, there are a lot of legal ins and outs to making demands for payer compliance.  We believe our articles and resources at AppealLettersOnline.com provide the supplemental how-to necessary for success.

Do you have a performance improvement or efficiency suggestion to share with our members?  Please share your information at our AppealLettersOnline.com user's forum under the discussion topic, "Denial Management."

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