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 claims management, denial prevention minimizes numerous downstream medical billing woes. In fact, recent research into denial management puts the cost of working a denied claim at around $118 per claim and outsourcing this function drives costs much higher. Despite this expense, denial management training has been largely left out of the staff development schedule for lack of any comprehensive training resources beyond occasional vendor sales webinars touting new software enhancements. One way to minimize the denial management impact is to schedule denial management staff training through the revenue cycle department.

When it comes to denial management, your staff needs education not complication. Your denial management training should be specific to each department’s operation needs. However, all departments – from patient access to collections – should have training on their specific denial management performance indicators and best practices.

Because of the challenges of denial management training delivery, Appeal Solutions has designed a new website dedicated to denial management training. is the only source of comprehensive denial management training resources available. At Appeal Solutions, we have trained thousands of medical professionals face-to-face on denial management and have now collected our go-to training materials into a web-based training program for any medical billing professional and/or organization to subscribe to. Our members achieve outstanding success with our material because it is both professionally developed and user tested everyday by our members, updated regularly and covers the gamut of medical billing issues faced across the spectrum of specialties and payers.

The bottom line is that the appeal process is abysmally underutilized by both patients and medical organizations. According to Tammy Tipton, President of Appeal Solutions and author of the course content, most healthcare organizations don’t file appeals because the appeal process is viewed as both biased in favor of payers and lacking in quality dialogue related to claim management challenges.

“Study after study shows that neither patients nor providers are very active using the appeal process. Despite many new protections related to appeal access, many really see it as waste of time,” Tipton said. “However, we see quality really increasing as medical billing professionals become more effective at citing the legal protections that apply to appeals. Medical billers are always very eager to learn what they can do to better advocate for the docs and patients. There are thousands of success stories out there and each win assures a better healthcare system for all. I am excited every time I work with an organization on denial management training.”

While Tipton said they have provided extensive training via webinars and onsite consultations, it was time to put the course materials out to a wider audience. The resulting website – – started taking members in August, 2017, and currently features over 40 denial management courses and thousands of appeal letter templates categorized by denial type. is unique in providing dual ammunition in the fight for fair medical payment. For optimal results, medical billing professionals need resources for preventing denials but also for contesting denials. has more than 40 courses designed to cover staff training on each type of denial, how to prevent the denial and how to address the denial if it does occur. Second, Pro subscribers to also get unlimited access to the website’s database of 1600 appeal letter templates. According to Tipton, the appeal letter templates are already utilized by thousands of clients to appeal denied claims and far surpass other appeal letter collections commercially available. These letters are effective because most of the letters include legal citations so that users can easily ask for both clinical and legal review of denied claims. Numerous consumer protections apply to medical claim determinations but often go uncited and unreviewed when medical providers appeal on behalf of their patients. The courses explain these legal protections and also make it much easier for medical billing professionals to demand high quality, unbiased reviews and better dialogue with payers.

Free memberships are available at so that organizations can assess how the program could be utilized at their organizations. A Pro level membership with unlimited access to the content is only $47/month. This membership allows your organization to better prepare for ongoing challenges with every payer – from the Aetna’s and Anthem’s to the Goliath known as United Healthcare Group – and assure quality healthcare is not threatened by poor claim decisions.

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