Appeals Toolkit: Turn Healthcare Insurance Denials Into Dollars
Manual & CD-ROM Resource Kit
11" x 8.5"
HCPro / Opus
(click button below for the very best currently available price for this important resource)
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 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 include 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 contractual adjustments
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.
When you purchase the Appeals Toolkit you will also receive trial access to a website with a vast resource of state-specific information. Search through hundreds of state-specific letters that cover issues such as prompt payment and fair precert. You will also find medical necessity definitions for each state and Medicare-specific resources. You will have access to downloads of hundreds of state-specific letters and the option to become a paid subscriber.
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
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.
With more than 17 years of experience, HCPro, Inc. is a leading provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare regulation and compliance. The company's mission is to meet the specialized informational, advisory, and educational needs of the healthcare industry. As an acknowledged industry authority in healthcare regulation and compliance, HCPro focuses on providing its clients assistance and expertise in the areas of accreditation, medical staff affairs, credentialing, privileging, medical record management, regulatory compliance, nursing, quality/patient safety, infection control, and workplace safety.
(information from the publisher)
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