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Appeals

Appeals

ERISA Regulations

Win More ERISA Appeals: Why the Summary Plan Description Is Your Secret Weapon

Most practices lose ERISA appeals before they even start — not because the clinical documentation was weak, but because they’re arguing with the wrong party entirely. Here’s a common assumption that undermines strong appeals: the name on the insurance card belongs to the entity with final authority over your claim. It often doesn’t. In many […]
Published Date: August 3, 2026
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Appeals COVID waivers

Denied Medical Claims? How to Write Effective Appeal Letters That Work

If your practice is dealing with denied claims, you’re not alone—but ignoring them is costing you real revenue. Industry data shows that up to two-thirds of denied claims are recoverable, yet 50–65% of denials are never worked. That means your practice is likely leaving thousands of dollars on the table every month. Worse, each denied […]
Published Date: May 20, 2026
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Medical Appeal Letters Made Simple: 10 Smart Strategies to Win More Claims

If you’re tired of watching revenue slip through the cracks because of denied claims, you’re not alone. Denials are one of the biggest threats to your practice’s cash flow—and the good news is, many of them are appealable and winnable. This guide breaks down 10 essential appeal letter strategies (based on real-world training insights) so […]
Published Date: May 5, 2026
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payer audit reimbursement appeals

How to Survive a Payer Audit and Win Your Reimbursement Appeals

When your practice receives a payer audit or reimbursement appeal request, it can feel overwhelming — especially when hundreds of medical records are involved. These audits are no longer rare or random. In 2026, both government and commercial payers are increasing audit volume, tightening medical necessity reviews, and aggressively recouping payments. If you respond without […]
Published Date: February 16, 2026
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E/M downcoding

3 Elements Your Appeal Letters Are Missing and How to Fix Them

If your medical insurance appeal letters are highly successful, then you’re one of the lucky few. The reality is that most practices see their appeal letters get tossed out, leaving their hopes of overturning denials dashed. One reason many appeals are rejected is because practices make mistakes on them. Check out three elements that many […]
Published Date: October 7, 2025
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Are Revenue Cycle Bottlenecks Costing Your Practice Thousands?

Dr. Lopez’s busy orthopedic practice submits hundreds of claims every week. But with denials creeping up, the billing team is constantly resubmitting claims. One front-desk employee, unfamiliar with payer rules, keeps entering incomplete patient insurance data—forcing staff to chase patients for missing information. Meanwhile, credentialing delays keep a new physician from being properly enrolled with […]
Published Date: July 24, 2025
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Medicare appeals

3 Times Medicare Appeals Aren’t Accepted & What to Do Instead

Submitting Medicare appeals is never at the top of anyone’s list of favorite things to do. It is, however, an essential tool in your revenue cycle toolkit so you can collect for your denied claims. Most practices find out eventually that Medicare appeals don’t apply to every situation. Discover three times you can’t submit one, […]
Published Date: March 24, 2025
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erisa

How ERISA Can Help Back Up Some Timely Filing Denials

It happens from time to time: Your provider agreement dictates one time period as the timely filing deadline, and the patient’s policy notes a different time period. If this discrepancy is confusing, that may be because insurers like it that way. However, if you have ERISA on your side, you can sort through this issue […]
Published Date: September 10, 2024
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Insurance appeal letter

Master the Perfect Insurance Appeal Letter in 4 Easy Steps

When you get a denial from your payer, your first step may be to immediately start putting together an insurance appeal letter so you can capture the pay for services you’ve provided. That’s an excellent habit, as long as you know what to include in your letter. Check out four steps that can help you […]
Published Date: July 1, 2024
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Insurance appeal

5 Common Insurance Appeal Errors (and How to Fix Them)

Medical insurance claim denials can be devastating to deal with. Not only do they take time and energy — they prevent your practice from collecting revenue for services you’ve already performed. The most common way to tackle a denial is to file an insurance appeal, which can help you reverse those denials. To ensure that […]
Published Date: May 6, 2024
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