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
Most Popular
- Articles
-
- Practice the six rights of medication administration
- The positive aspect of change
- Don’t forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Differentiate between types of wound debridement
- What to include on the incident report
- OB services: Coding inside and outside of the package
- Know guidelines and subtle differences in code descriptions for laceration repairs
- What is the difference between an IPA and a medical group?
- ICD-10-CM coma, stroke codes require more specific documentation
- E-mailed
-
- CMS isn't done with emergency preparedness
- Learn documentation requirement for critical care coding in the ED
- Know the medical gas cylinder storage requirements
- Q/A: Extended recovery time
- Bear in mind these coding and documentation tips for lesion excisions
- Alcohol and drug addiction recovery month
- Hospital-Acquired Conditions drop 13%
- Get to the heart of cardiac catheterization coding
- Four sentenced in Miami Medicare fraud scheme
- Ensure coding accuracy by following rules for selecting a principal diagnosis
- Searched