by Intersect Healthcare | Oct 22, 2018 | Appeal Writing, Medicare, Revenue Cycle
By R. Kendall Smith, Jr., MD, SFHM A report released by the HHS Office of Inspector General (OIG) in September 2018 found that Medicare Advantage Organizations (MAOs) overturned a jaw-dropping 75 percent of their own denials from 2014 to 2016. Even more startling was...
by Intersect Healthcare | Apr 5, 2017 | Appeal Writing, Appeals, Medical Records, Medicare, Resources
Reprinted with permission by the Report on Medicare Compliance Fed up with claim denials for inpatient admissions by Medicare Advantage (MA) plans months after they were approved, Self Regional Healthcare in Greenwood, S.C., complained to the CMS regional office in...
by | Jul 3, 2015 | Appeal Writing, Appeals, Evidence Based Guidelines, Medical Records, Resources, Standards of Care
Including payer payment guidelines in your appeal letter templates can increase the efficiency and effectiveness of your appeal writing. Most payers develop and publish very specific payment guidelines for medical and surgical procedures. This ensures payment is made...
by | Jun 4, 2015 | Appeal Writing, Appeals, Evidence Based Guidelines, Medical Records, Resources, Standards of Care
Insurance company denials of payment are rarely issued in a random and infrequent manner. Most denials for services rendered are grouped around specific issues on payment policies, as defined by the insurance carrier. As an appeal writer, it only makes sense to...
by | Mar 25, 2015 | Appeal Writing, Appeals, Resources, Standards of Care
Limitation on Liability is a very common phrase to appeal writers, specifically when dealing with government denials. It’s a crucial argument that is vital to a winning appeal argument. Have you ever stopped to think about what that phrase means? Have you ever dug...
by | Feb 26, 2015 | Appeal Writing, Appeals, Resources, Standards of Care
There is no reason to ever write an appeal letter from scratch. You will never write just one appeal for chest pain or knee replacement surgery. Denials come in multiples. The only difference from the first chest pain denial and the twentieth is the circumstances of...
