Case Management

Tips for crafting a successful appeal letter

Case Management Monthly, July 1, 2010

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.

It takes knowledge and skill to navigate the appeals process. 

The appeal process is much more complex than conducting a clinical review for an insurance company. Appeal writers must complete a full review of the record and consider multiple sources, such as CMS guidelines and managed care contracts, to successfully argue their case. 

The best appeal writers have clinical expertise and an understanding of the hospital’s preferred clinical criteria (e.g., InterQual, Milliman). 

Appeal writers must do their homework before they begin to write an appeal letter. The following steps will help gather the information to support an appeal.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Case Management Monthly.

Most Popular