Practice Management Alert

Customize this expert letter with supporting evidence, and your appeal will be ready to go

Medicare recently identified "unbundling" as one of its top-10 reasons for denying claims - but you should never just settle for that denial.

Increase the power of your denial management process by using this appeal letter template provided by Maggie Mac, CMM, CPC, CMSCS, consulting manager with Pershing, Yoakley & Associates in Clearwater, Fla. The letter is specially tailored for "unbundling" denials and will pack a punch with insurers once you've added specific supporting evidence to bolster your appeal.

Letter Template

Date

Address for payer/claims appeal department

RE:
Insured:
Patient:
ID #:
Date of service:
Claim #:

Dear [Name of claims adjudicator]:

This letter is to appeal your denial of payment for the attached claim.

You denied our claim for services rendered to our patient by erroneously bundling CPT code xxxxx and xxxxx with CPT code xxxxx-xx and allowing [less or no] payment for these codes.

You indicate that [CPT code xxxxx, name of service rendered], should be bundled with the other services provided rather than being billed separately.

However, CPT coding guidelines do allow for a separate charge in this instance. We have confirmed this with the Correct Coding Initiative version XXX and consulted CPT Coding Guidelines as provided by the American Medical Association. [Insert your customized evidence here]. Based on this information, we expect to receive additional payment for our claim.

If you have any questions or would like to discuss this further, please call me at (xxx) xxx-xxxx.

Thank you for your immediate attention to this matter. I will look for your reply within 14 days.

Sincerely,
Your name

Your title

Practice name 

*You may want to attach copies of the pertinent NCCI edits, AMA guidelines, etc. to strengthen your argument.

 - Letter template reviewed and edited by Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.