Can five sentences really mean the difference between appeal success and failure?  Speaker Tammy Tipton will explain the importance of each of the five sentences and describe what laws can actually force carriers to be more responsive to each sentence. The first four sentences to be discussed are as follows:

Can five sentences really mean the difference between appeal success and failure? Speaker Tammy Tipton will explain the importance of each of the five sentences and describe what laws can actually force carriers to be more responsive to each sentence. The first four sentences to be discussed are as follows:

Sentence 1: This letter is to notify you that our office has obtained an assignment of benefits for treatment rendered which is enclosed for your records.

Sentence 2: We request peer-to-peer conversation regarding this denial to facilitate the complete review of the denial between medical professionals with the same or similar medical credentials and training.

Sentence 3: If peer-to-peer review is not provided, please provide the following information which should have been disclosed with the initial denial: name and credentials of the original reviewer, complete copy of internal clinical or coding guidelines applicable to denial, outline of any records needed to further review claim and recommendation regarding alternative care and/or coding.

Sentence 4: It is our position that failure to provide the requested information may violate state and/or federal claim processing disclosure laws or, in the minimum, non disclosure reflects a poor quality medical process which discourage treatment provider input.

Sentence 5: This is likely the most powerful addition to your appeal letter and will be discussed during the presentation. Five sample appeal letters will be included in the presentation to demonstrate how to incorporate the suggested wording into your existing appeal letters. A Question and Answer session at the end will allow participants to inquiry about denials specific to their organizations.