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 and could serve as a key driver in behavior modification. The barrier, of course, is insurance coverage.

Eleven major US insurance companies covering more than 160 million lives . . . Read More

AppealTraining.com Featured Letters

The AppealTraining.com website has letters which cite the URAC standards related to appeal review and peer conversation. The URAC appeal letters are under Topic: Medical Necessity, Subtopic: Case Management Standards. These letters can be used to request peer conversation or to contest a poor quality peer conversation process:

1. Appeals Consideration
2. Lack of Appeal Response
3. Lack of One Day Response
4. Lack of Timely Decision
5. Lack of Written Decision
6. Peer-to-peer Conversation
7. Records Request Response
8. Reversal of Certification Determinations

Be sure and review the letters under Topic: Medical Necessity, Subtopic: State Medical Necessity Terms for additional state regulations applicable to peer review.

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Webinar: 50 Appeal Letters and How To Use Them Like A Pro

Date: January 16, 2018

It’s a fact: A well-written appeal is your most effective tool for challenging an insurance claim denial. In this audio conference, presenter Tammy Tipton will provide 50 of Appeal Solutions’ most effective Level I and Level II Appeal Letters and share the strategies to make these appeal letters collect on unfair denials.

A nationally-recognized authority on this topic, Ms. Tipton will explain, clearly and concisely, specific tactics for selecting and preparing the right appeal letter for a wide range of denials.  She will also assist participants with understanding their legal rights and how to argue those rights effectively when carriers uphold denials unfairly.

Sign up today for this on-demand webinar and get a FREE 30-Day PRO AppealTraining.com Membership and 1 CEU Credit. You'll get unlimited access to over 40 video training courses, 1600 appeal letter templates, and much more! Sign up today to attend this Webinar.