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Quality of Appeals Reviewer
Are your appeals getting a response from a Qualified Appeals
Reviewer?
Urologists
don’t recommend patients for open heart surgery. So
should a urologists hired by an insurance company be allowed
to make utilization review or appeal decisions related to
cardiology treatment for an insurance company?
Find out how to ensure your appeal reviews are conducted by
qualified personnel. |
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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 May 26th at 11 a.m.
CST.
The audioconference is also available on CD-Rom.
Click here for details... or call 888-399-4925. |
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AppealLettersOnline.com New Letters
AppealLettersOnline.com
is adding state-specific letters to assist users with
submitting payment inquiries and appealing suspected
workers' compensation underpayments. The letters are
being added to our online letter repository as follows:
Now Available: Workers' Compensation Fee
Schedule/Payment Inquiry for Alabama through Montana.
Coming in May: Workers' Compensation Fee
Schedule/Payment Inquiry for Nebraska through Wyoming.
These letters are designed to assist providers with citing
state laws in regards to unfairly delayed or reduced
workers' compensation 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.....sign
up to access
these appeal letters at www.AppealLettersOnline.com |
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Specialty Highlight:
A
number of different specialty care providers are reporting a
high rate of denials on assistant surgeon claims.
In appealing assistant surgeon denials, it is important to
require the insurance company to clarify if the denial is
based on specific policy exclusions, medical necessity
limitations or the credentials of the assistant surgeon.
You will also want to cite any recognized industry standard
regarding reimbursement of the charges, including Medicare
reimbursement policy, even if the coverage is not bound by
those standards. Although Medicare reimbursement
policy is not necessarily binding on commercial medical
claims, it can be persuasive information in the absence of a
clearly-worded exclusion. Finally, it is important to
explain exactly what services the assistant surgeon provides
during the course of surgery and the skill level necessary
to perform the required tasks.
We have added a letter to the Topic "Medical
Necessity,"
Subtopic "Medical
Necessity By Condition,"
which assists users in appealing denials for assistant
surgeon charges on gastric bypass claims. Look for the
letter titled "Gastric
Bypass – Asst Surgeon Charges."
While your claims may be for different procedures, this
letter serves as a guide on how to customize an appeal
letter related to other procedures. Any questions or
comments about how to best customize this type of letter for
a different procedure can be posted to the
AppealLettersOnline.com Users Forum specific to your
specialty.
Letters appealing assistant surgeon charges should also
routinely include the operative report and the assistant
surgeon’s medical license information....sign
up to access
these appeal letters at www.AppealLettersOnline.com |
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