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General Surgery Coding Alert

Reader Question:

Skip 'Form Letters' if You're Hoping for Appeals Success

Published on Mon Jul 18, 2011

Question: After checking to be sure we haven't made a coding or billing entry error, our practice automatically appeals payer denials using a standard letter. We don't seem to be very successful in ultimately getting payment. How can we improve our appeals process?Texas SubscriberAnswer: Successful appeals depend on knowing coverage rules and providing specific information to make your case. Form letters don't address either of those advantages, so follow these tips to get better appeals results.Check policies: Before you begin the appeal process, first check the payer's policies. If you discover that your surgeon performed a procedure that doesn't show medical necessity according to those policies -- due to bundling or frequency rules, for instance -- don't bother to appeal. Writing appeals is time-consuming enough, so you don't want to waste time on appeals you cannot win because there is already a specific policy in placeSubmit to procedure: Next, be sure you [...]
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