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Appeals

Appeals

ERISA documents

How to Gather ERISA Documents That Help You Slash Denials

The first step to filing ERISA appeals is to ensure you have all the ERISA documents you need from your patients — but that can be easier said than done. It can be challenging to get items like the summary plan description and coverage details. Check these methods that can help you gather the ERISA […]
Medicare appeals

7 Tips for Medicare Appeals That May Help Reverse Denials

Unless you engage a consultant or attorney to assist, it costs nothing to submit Medicare appeals, but it can net you big money because you’ve already performed the service — and you deserve to get paid for it. Many practices avoid appealing denials because it’s time consuming, but if you know the ropes about Medicare […]
Insurance appeals

Master the Insurance Appeal Timeline to Fight Payer Denials

Working in healthcare is stressful enough without having to track your appeals on the calendar — but staying on time and meeting appeal deadlines will be essential if you want a strong chance of payers reversing their denial decisions. Your best bet in setting up your insurance appeals for success will be to make sure […]
Medicare appeals

5 Pitfalls to Avoid When Appealing Medicare Claims

No one likes to get a claim denial from Medicare. You have a few options in this situation: Either appeal the claim or eat the cost of the denied service. In most cases, filing Medicare appeals will allow you to boost the odds of getting paid, but you must avoid these five common pitfalls. 1. […]
denied claim appeal letter

Include These 5 Items in Your Appeal Letter to Achieve Success

Every medical practice has been there: You get a notification from an insurer that your claim is being denied, downcoded, or held for more information. In many cases, this can mean thousands in lost reimbursement for a service you’ve already provided. Therefore, your best bet is to appeal inappropriate denials so you can recoup the […]
RAC Audit

RAC Audit Response and Appeal Survival Tactics

Although last year’s pandemic put a brief pause on Recovery Audit Contractor (RAC) audits — this year they are once again in full swing. Auditors are picking up the pace to make up for lost time. So, your chances of getting audited are higher than ever before. What is a RAC Audit? RAC audits are […]
third-party payer appeals

6 Tips for Successful Third-Party Payer Appeals

When even the slightest mistake on a claim form can lead to a denial or reduced reimbursement, you need to be on your toes. The good news is with some leg work third-party payer appeals can get you paid more of what you are due. While third-party payer appeals are a time-consuming complex process, they’re […]