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ISSUE 48 February 12, 2008
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Who’s Reviewing Your Appeals? Man or Machine?
Appeals involve highly technical issues such as clinical guidelines, specialty coding
standards, quality of care and contract requirements. Computers are not good at
appeal review. This article discusses how to ensure you receive quality appeal reviews by
a qualified, credentialed reviewer.
Read this entire article...
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AppealLettersOnline Featured Letter
AppealLettersOnline.com has a new letter to assist subscribers with seeking appeal review by a
credentialed medical reviewer and/or active practice health professional. See
the new letter entitled "Request for Review By Qualified Reviewer" under the
Appeals Repository Topic, "Medical Necessity" and the subcategory, "State
Medical Necessity Terms." Also under this category, see the range of
state-specific letters which will assist subscribers in citing state, ERISA and
Medicare requirements regarding appeal reviewers qualifications.
Sign up to access this letter
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50 Appeal Letters & How To Use Them Like a Pro:
Appeal Solutions will present 50 Level I and Level II Appeal Letters on March 4. Tammy
Tipton, President of Appeal Solutions and author of HCPro’s "Appeals Toolkit,"
will discuss how to assert your rights when insurers deny or
underpay your claims. The 90-minute presentation will focus on assessing Level
I appeal responses and how to respond to poor appeal reviews with effective Level II appeal letters. The presentation also includes:
- Lack of timely filing appeals and using affidavits for establish timely filing.
- Selecting the most appropriate letter for each appeal and determining which state and/or federal laws to know and use for each type of appeal.
- Coding appeals and demanding a review by a certified coder.
- Seven tips to improve medical necessity denials with the help of
our Level I and II Medical Necessity Appeal Letters.
- Getting a move on stalled claims by citing regulatory information.
- Maximum Benefit Appeals and How To Respond.
- Refund/Recoupment Response letters.
A sample appeal letter is available. Click here for more info or to sign up.
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