Increase Pay-up by Successfully Appealing Claim Denials
What if every time you had
a patient in v-fib, you were allowed to shock him only once? What would
your success rate be? Everyone in EMS knows that defibrillation often
works only on the second, or even the third, shock. The same principle
holds true when it comes to getting reimbursed for medical transportation.
It often takes one, even two, appeals before claims are paid. In fact, as
many as 50 percent of denied claims are eventually paid when the provider
appeals the Explanation of Benefits (EOB).
“Insurance companies deny
thousands of claims a year with what appears to be substantial evidence to
support such non-payment,” explained Tammy Tipton, president of Appeal
Solutions, a manufacturer of software to help process EOB appeals. “They
do this knowing that most denials are accepted without question or action.
They know many medical providers do not have the time, legal expertise and
insurance industry experience to investigate the basis, or lack thereof,
of claim denials.”
AppealLettersOnline.com provides articles & case studies to assist
medical providers resolve denied insurance claims.
Download Sample Appeal Letters
AppealLettersOnline.com can assist providers implement an effective denial management program.
You will find appeal letters,
case studies, articles, other resources and the latest intelligence necessary to help healthcare providers make
vital decisions and take strategic actions to address payer denial issues.
AppealLettersOnline.com will help health care
providers actively develop the processes, analytical tracking information, educational programs and procedures needed for
implementing an effective denial management program.
Download Sample Appeal Letters
Some of the topics covered at AppealLettersOnline.com include addressing payment reductions such as usual and
customary and out-of-network care reductions, lack of timely filing denials, pre-existing conditions and medical necessity
appeals and improving verification of benefits procedures. Treatment exclusions, maximum benefits denials and
subrogation/coordination denials are also discussed.
Training & tips are provided on appealing for interest and penalty payment on
late payments and appealing a request for a refund of previously paid claims.
AppealLettersOnline.com discusses all types
of claims including Managed Care, Indemnity, Government, Self-Funded, ERISA
claim issues and managed care contractual payment discrepancies.
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- Medical Necessity
- Timely Filing
- Preexisting Conditions
- Lack of Precertification
- Benefit Reductions
- Refund Requests
- Stalled Claims
- Specialty Care Appeal Reviews
- Workers' Comp
- Verification of Benefits Issues
- Coding Issues