Turn healthcare insurance denials into dollars
Combat denied claims and get paid what you deserve
Don’t take no for an answer! You can turn denied insurance claims on their head and recover millions of dollars in lost revenue – revenue that your organization deserves. Be informed of your legal rights and use them to your advantage when submitting denied claims.
Here’s your biggest ally in fighting denied claims: The Appeals Toolkit: Turn healthcare insurance denials into dollars provides extensive information on appeal strategies and methods to incorporate into your processes to avoid being denied in the first place.
Sample letters found in this comprehensive resource… no need to look anywhere else!
The Appeals Toolkit includes 25 tested, proven, and effective sample appeal letters from which you can model your own claims. These letters demonstrate the inclusion of legal citations and how to effectively demand a thorough response from a carrier.
You’ll have access to appealing the following denials:
- Incorrect payment
- Incorrect contractual adjustments
- Medical necessity
- Utilization review
- And more!
- As an added bonus, you will receive chapters dealing with appealing claim denials for Medicare and the Employee Retirement Income Security Act (ERISA)
Accompanying CD allows you to customize
Use the book version of the Appeals Toolkit for quick reference, or use the accompanying CD-ROM to download the letters and customize them to your specific situation. You can simply search the denial area you need, then copy, paste and edit to suit your needs.
This book will pay for itself!
If you implement these tools, you will recover money right away without spending significant time on each appeal. The cost of this kit could be recovered with one overturned denial!
Take a look at the Table of Contents
Chapter 1 – Introduction; Providers rights regarding appeals; Legal protections and limitation applicable to provider appeals; Assignment of benefits review
Chapter 2 – Obtaining insurance information; Pretreatment strategies for benefit clarification; How to demand benefit disclosure and appealing misquoted benefits and coordination denials
Chapter 3 – Utilization management; Appeals start in UM; Demanding timely, thorough responses to UR requests
Chapter 4 – Medical necessity; Evidenced-based medicine; Demanding expert review and uncovering basis of carrier denials
Chapter 5 – Incorrect payments; Identification, rapid response, and how disclosure protections should be cited in appeals
Chapter 6 – Mandatory coverage laws; How are use consumer protections laws applicable to health insurance benefits; Emergency treatment; Mothers/newborn coverage and mental health treatment protections
Chapter 7 – Treatment exclusions and limitation; Maximum benefits; Experimental treatments; Treatment caps
Chapter 8 – Refund and recoupment; Contractual obligation and effective responses
Chapter 9 – Level II appeals and beyond
Chapter 10 – ERISA
Chapter 11 – Medicare appeals
About the author:
Tammy Tipton is President of Appeal Solutions, Inc. and the co-author of Power of Appeals Denial Management System. She has written extensively on medical receivables management and has frequently lectured on conducting successful appeals and using today’s complex legal system to protect healthcare claim assets.
If for any reason Appeals Tool-kit does not meet your needs, return it within 30 days and you will receive a prompt, polite 100% refund… no questions asked.
Published: November 2007