For a new appeal writer, learning the language of health insurance can be daunting, especially if one’s background is clinical and not business oriented. I remember as a newbie reading the CMS regulations on payment policies over and over again. I’d tease out every nuance of what was written and follow every reference down every rabbit hole until I finally gained a working knowledge of the system. I doubt I’m alone here.
Think of the appeal process as a conversation between provider and payer. Maybe not the easiest and smoothest of conversations, to be sure, but it’s what we have to work with today.