Aetna Medical Director Denies Care Without Reading Submitted Medical Records
It is sort of rare to see any kind of “stunning admission” by an insurance giant. But this week’s headline about an Aetna Medical Director who made important decisions on claims without reading the medical records has been met with mounting frustration over lack of quality in payer review. In the CNN story, Dr. Anne-Marie…
Precision Medicine Reimbursement: Two Routes to Payment
Patients want personalized healthcare and healthcare organizations are looking for ways to provide it. However, the growth of medical options under the Precision Medicine category are being stalled by the ever present issues of reimbursement. Among the most highly utilized, genetic tests that can identify patients with a higher risk for cancer are hugely popular…
Stop The Spread Of Denied Claims – Denial Prevention Can Work
A sudden spike in denied medical claims can clog up your entire financial spreadsheet, sending red ink into columns and rows where root causes hide and finger pointing starts. Just like your doctors often intone in the exam room – an ounce of prevention is (yes, really is) worth a pound of cure. In healthcare…
Increase Pay-up by Successfully Appealing Claim Denials
What if every time you had a patient in v-fib, you were allowed to shock him only once? What would your success rate be? Everyone in EMS knows that defibrillation often works only on the second, or even the third, shock. The same principle holds true when it comes to getting reimbursed for medical transportation.…
Precertification ICD-10 Training Recommendations
How can your organization anticipate and prepare for Payer ICD-10 pre-certification performance interruptions? We recommend developing a ICD-10 training program for pre-certification staff focused on Payer Performance Monitoring. Yes, precertification staff need the traditional elements of basic ICD-10 role-based training, However, consider adding the following Payer Performance Monitoring initiatives to your precertification training session: Impact…
Physician Role in Patient Advocacy: Getting to YES in Peer Review
Physicians often lament the days of yore when treatment decisions were made in the exam room and not the insurance company board room. However, a healthcare consultant who specializes in assisting healthcare organization secure coverage for new medical technology says physicians still have a say in individual coverage decisions. Mary Corkins, Founder of The Reimbursement…
Seven Tips To A Successful Medical Necessity Appeal
AppealTraining.com has a number of letters citing state and federal disclosure laws which assist medical providers with demanding more complete information regarding denials. These letters are under the Topic: Benefit Reductions and the Subcategory: State Mandates in the AppealTraining.com Appeal Letter Repository and include a number of new state-specific disclosure letters. Request Immediate Peer-to-Peer Review.…
An Ounce of Appeal is Worth a Pound of Payment
The health care hue and cry grows louder everyday. Medical and mainstream publications are filled with stories focusing on the barriers doctors and hospitals face in getting paid in today’s health care environment. Precertification, managed care and tight timely filing deadlines are just some of the hurdles medical professionals must finesse when seeking reimbursement. And…
New Power of Appeals Reports
Are your organization’s financial vital signs hard to take? The increasing complexity of medical reimbursement means increasingly complex financial health analysis. Power of Appeals software is the leader in denial management with its powerful database of 1600 compliance-focused appeal letters. Now, Power of Appeals provides additional financial analysis tools to allow users to achieve better…
Quote From Favorite Book
If you ever find yourself tired of appealing denials and advocating for care, reading the book “Negotiating From An Uneven Table: Developing Moral Courage In Resolving Our Conflicts” may be the verbal elixir you need. Nurse and author Phyllis Beck Kriteck spells out how to maintain a moral backbone in the world of unevenly granted…
