tci Medicare Compliance & Reimbursement - 2011 Issue 9

Reader Questions: Cookie Cutter Appeal Letters Won't Bring in the Cash

Question:After checking to be sure we haven't made a coding or billing entry error, our practice automatically appeals payer denials using a standard letter. We don't seem to be very successful in ultimately getting payment. How can we improve our appeals process? Louisiana SubscriberAnswer: Before you begin the appeal process, first check the payer's policies. If, for example, the payer has a policy that bundles dipstick urinalysis (81002) into any E/M services performed on the same day and will not be reimbursed separately, don't appeal these. Writing appeals is time-consuming enough, so you don't want to waste time on...

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