Case Management

Case management Q&A

Case Management Weekly, October 17, 2012

Q. Who should write appeals letters?

 A. Appeals letters should be generated by an appeals nurse. Depending on the model, the appeals nurse might be part of the case management/utilization department, billing department, finance department, or even a separate appeals department. Some hospitals contract with companies that specialize in appeals, and they are responsible for generating appeals letters, often written at the behest of a physician.
The individual responsible for writing the letter should have knowledge of InterQual® and a clinical background. Most facilities designate a nurse to write and sign these letters.
Editor’s note: This Q&A is adapted from Prevent Denials and Win Appeals: The Hospital Case Manager’s Guide to Revenue Integrity published by HCPro, Inc.

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