eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 56 Nov 12, 2008















































Fee Schedule Renegotiation
Do your payers know about your quality improvements?  Your commitment to quality may be focused on patient care but your payers benefit too.  Your payers may even be willing to pay higher fees schedules for proven results resulting from quality of care programs.  Why not ask?  Appeal Solutions has developed a Fee Schedule Renegotiation Request letter to easily initiate negotiations for fee schedule increases. . . . Read this article >>
AppealLettersOnline Featured Resources has new information on managed care negotiations under the Topic Contract Negotiation. See this area for the most commonly overlooked managed care contract protections as well as suggested contract wording. There are a number of helpful documents under Contract Negotiation including the following:
  • Sample Letter for Requesting Fee Schedule Increase (New!)
  • Sample Letter for Requesting Management Care Contract Renegotiation
  • Notification of Claim Negotiation with Third Party Repricing Company (New!) - Useful when a payer contracts with other third-party repricing companies to negotiate payment but doesn't always honor such agreements after a payment agreement is reached
  • Appeal Letter Attachment Documentation: Tracking Memos for Utilization Review/Case Management Department
Access these letters >>
Audio Conference: 5 Sentences To Improve Your Medical Appeals
Our newest Appeals Audioconference Training course will help you transform your appeal letters.  5 Sentences to Improve Your Medical Appeals, will be held Dec. 16 at 11 a.m. Central. 

Can five sentences really mean the difference between appeal success and failure?  Speaker Tammy Tipton will explain the importance of each of the five sentences and describe what laws can actually force carriers to be more responsive to each sentence.  The first four sentences to be discussed are as follows:

Appeal Improvement 1: This letter is to notify you that our office has obtained an assignment of benefits for treatment rendered which is enclosed for your records.

Appeal Improvement 2: We request peer-to-peer conversation regarding this denial to facilitate the complete review of the denial between medical professionals with the same or similar medical credentials and training.

Appeal Improvement 3: If peer-to-peer review is not provided, please provide the following information which should have been disclosed with the initial denial: name and credentials of the original reviewer, complete copy of internal clinical or coding guidelines applicable to denial, outline of any records needed to further review claim and recommendation regarding alternative care and/or coding.

Appeal Improvement 4: It is our position that failure to provide the requested information may violate state and/or federal claim processing disclosure laws or, in the minimum, non disclosure reflects a poor quality medical process which discourage treatment provider input.

Sentence 5, likely the most powerful addition to your appeal letter, will be discussed during the presentation.  Five sample appeal letters will be included in the presentation to demonstrate how to incorporate the suggested wording into your existing appeal letters.  A Question and Answer session at the end will allow participants to inquiry about denials specific to their organizations.  Cost is $249 for the 90-minute presentation and may include any number of employees listening on one phone line.

Sign up to participate or read more about this audioconference >>