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.
Related Products
-
The Compliance Officer's Handbook, 2nd Edition
This revised edition is packed with even more practical tools, case studies, tips and tools, sample audits, and sample...
-
The RAC Toolkit for Hospitals and Health Systems
The RAC Toolkit for Hospitals and Health Systems: Manage Responses and Avoid Claims Under the Permanent Program is your...
-
Combat RAC Denials: Strategies for Successful Appeals
During this 90-minute audio conference, our speakers provide step-by-step procedures, timelines, tools, and best practices...
-
The RAC Toolkit for Physician Practices
The RAC Toolkit for Physician Practices is your practice’s answer to turning plans into proactive action for RAC success...
-
Stark Law, 2nd edition: A user's guide to achieving compliance
This updated version of HCPro's Stark Law best seller, first published in 2005—and now co-authored by former CMS Stark...
Most Popular
- Articles
-
- Note similarities and differences between HCPCS, CPT® codes
- Don't forget the three checks in medication administration
- The consequences of an incomplete medical record
- Coronavirus: 7 Infection Prevention Best Practices for Healthcare Settings
- Practice the six rights of medication administration
- OB services: Coding inside and outside of the package
- Q&A: Primary, principal, and secondary diagnoses
- Skills of effective case managers
- Complications from immobility by body system
- Neurological checks for head injuries
- E-mailed
-
- The consequences of an incomplete medical record
- Right- and left-brain learners: Strategies to facilitate hemisphere learning
- QA:Coding multiple initial infusions
- Q/A: Billing for DME
- Intake and output monitoring
- Hospitalists branch into perioperative medicine with preop assessments
- HIPAA Training Handbooks pick-a-pack!
- HCPro, Inc. Launches New HIPAA Products for Clinical Researchers
- Follow 72-hour and 24-hour rules
- Coding Clinic reiterates guidelines for provider documentation
- Searched
