The Appeal Letter

ISSUE 29 January 10, 2005

	Appealing Lack of Timely Filing denials. Are you just now learning about other primary coverage months after filing a claim with Medicare? CMS is undertaking a comprehensive effort to collect money owed to Medicare due to incorrect payments related to coordination of benefits and, as a result, providers may find themselves with timely filing denials from the primary insurer. Signup to AppealLettersOnline today to read the article on Appealing Lack of Timely Filing After an MSP Denial and to download the new appeal letter which cites restrictions on the primary carrier’s ability to assert the lack of timely filing defense.
	Audioconference on Appeals Train your entire staff on appealing denied and incorrectly paid claims for only $197. Appeals – When “Limitations and Exclusions Apply” Isn’t Good Enough is a 90-minute audioconference featuring information on asserting your rights when insurers provide canned denials. Tammy Tipton, President of Appeal Solutions, will discuss what laws apply to appeal review and how to use them in your favor to obtain such pertinent details as the credentials of the reviewer and the documentation in the claim file or policy which support the denial. Over 96% of past attendees have said that their facility benefited from this audioconference and that they would be implementing several of the techniques and appeal letters presented during the audioconference. The live audio conference will be held Thursday Feb. 17th at 11 a.m. CST. The audioconference is also available on CD-Rom. Click here for details... or call 888-399-4925.
	AppealLettersOnline.com Featured Letter AppealLettersOnline.com now has a letter for appealing lack of timely filing denials received from group health plans when an MSP claim was filed late due to failure to identify primary payer at the time of treatment. This letter cites Section 4632 of the Balanced Budget Act of 1997 which stipulates a three-year time frame for recoupment of incorrectly paid Medicare benefits and limits the applicability of the primary carrier’s timely filing limitation to related refund demands. The letter is entitled “Request for Primary Payment Subsequent to MSP Refund” and is available in the appeal repository under the Topic “Timely Filing Limitation” and the subtopic “Notification of Timely Filing.” If this appeal is not effective, you may want to discuss the group health plan’s denial with the Medicare MSP department for your region.......sign up for access to the appeal letter repository
	Specialty Highlight: AppealLettersOnline.com now features a new topic for workers compensation appeal letters. This topic will contain letters citing claim processing rules and regulations from each states’ workers compensation laws. Letters are being added to the repository over the next four months as follows: January: Prompt Payment of Medical Workers Compensation Claims for Alabama – Montana. February: Prompt Payment Appeals Specific to Workers Compensation Claims for Nebraska – Wyoming. March: Request for Review of Incorrect Payment for Workers Compensation Claims for Alabama – Montana. April: Request for Review of Incorrect Payment for Workers Compensation Claims for Nebraska – Wyoming. These letters are designed to assist providers with citing state laws in regards to unfairly delayed or reduced medical claims. Any questions or comments about how to best use these letters can be posted to the AppealLettersOnline.com Users Forum specific to Workers Compensation Claims.
	Managed Care Contract Negotiation Audioconference Set for January Appeal Solutions will be presenting the audioconference, Leveraging Denial Data in Managed Care Contract Renegotiations, on January 25th in conjunction with MedLearn, Inc. Tammy Tipton, president of Appeal Solutions, will be discussing how to best address denial issues at the time of contract renegotiation and use denial statistical information to negotiate more favorable contract terms. The live audio conference will be held Jan. 25 at 11 a.m. CST (12 a.m. EST, 1 p.m. MST and 2 p.m. PCS). Cost is $199 per dial in line. For more information about the audioconference visit http://www.medlearn.com/audio_seminars.htm