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ISSUE 45 November 6, 2007
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Medicare and Medical Necessity
Medicare appeals should address unique treatment challenges related to geriatric care which
may fall within the "medically necessary" definition...Read
this entire article |
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AppealLettersOnline Featured Letters
We have several letters which cite Medicare Appeal Protections including the following:
(New!) Medicare Quality Review Requirements under the Topic "Medical Necessity" and Subcategory "Medicare"
(New!) Medicare Medical Necessity Definition under the Topic "Medical Necessity" and Subcategory "Medicare"
Medicare Timely Appeal Review letters are available under the Topic "Stalled Claim" and Subcategory "Medicare"
It is important to remember that these letters
will be more effective if accompanied with any required forms.
Form CMS-20027,
"Medicare Redetermination Request Form," can be used to explain the basis of
the appeal.
Sign up to access these appeal letters
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California Appeals Audioconference
Appeal Solutions will conduct an audioconference presentation, "Using Califonia
law in Appeals" on December 11 at 11 a.m. Pacific.
California-specific claim processing regulations and
disclosure requirements will be discussed and instruction
given on how to best use such legal information in
utilization review and post treatment appeals as well as
during contract negotiations. Speaker Tammy Tipton will
explain how California law and regulations can be utilized
by patient access and case management to assist with
treatment approval. The 60-minute presentation will also
discuss the appeal letter content and demanding the highest
quality medical review at the insurance carrier. For more information or to participate in this audioconference, please call 888-399-4925 or
click here for details.
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