Audio Conferences

Audioconference Title:  Medical Necessity Appeals and Demanding a Quality Review by the Payer.

Audioconference Objective:  Medical billing professionals send detailed, persuasive appeal letters ever day. Despite these well-written efforts, many appeal letters result in “Denial Upheld.”  In this audio conference, presenter Tammy Tipton will discuss how to assess appeal responses for signs of a poor quality review. Strategies for demanding peer review, peer discussion, expert review and complete clinical disclosure will be explained.  Level II medical necessity appeal customizations will be demonstrated so that none of your higher level appeals are rejected due to “no new information.”

Key areas to be covered include:

  • Citing regulatory information to demand high quality medical necessity reviews
  • Timely appeal submission and how our appeal letter collection enables you to meet appeal submission deadlines
  • Asserting your rights with insurers including your right to demand and review the carrier’s internal rules and guidelines used to reach the adverse determination
  • What to do with standard form letter responses and what courts have said about payers’ irresponsible medical reviews
  • Using attachments to make your appeal stronger

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