Webinar: Medical Necessity Appeals and Demanding a Quality Review by the Payer

March 20, 2018

Do you know how to demand a high quality medical review process from payers? Do you want to make sure that when you submit records, they are not just read by payers but also understood? Do you want to cite potentially applicable legal requirements regarding quality review of appeals? 

Tammy Tipton, President of Appeal Solutions, will discuss how to assess appeal responses for signs of a poor quality review in the upcoming webinar, “Medical Necessity Appeals And Demanding A Quality Review By The Payer.”The webinar will be April 10 at 11 pm CST. Strategies for demanding peer review, peer discussion, expert review and complete clinical disclosure will be explained.

Trying to appeal medical necessity denials without knowing the payer criteria is like throwing darts blindfolded. However often payers are not transparent about clinical criteria and do not even provide peer discussion of the specifics of the denied treatment.

To make it easier for medical organizations to effectively appeal, Tipton will discuss critical legal protections which can be cited in appeals and review recent legal decisions. Further, many medical necessity appeal letters are more thoroughly reviewed by escalating denials to upper levels of review. Therefore, Tipton will discuss upper level medical necessity appeal customization and how to avoid rejections based on the common payer appeal response "no new information."  Further, participants will be given 14 medical necessity appeal letters to make it easy to use these well-worded demands for quality review. 

The webinar objections include the following: 

  1. Citing regulatory information to demand high quality medical necessity review

  2. Timely appeal submission and how our appeal letter collection enables you to meet appeal submission deadlines

  3. Asserting your rights with insurers including your right to demand and review the carrier’s internal rules and guidelines used to reach the adverse determination

  4. What to do with standard form letter responses and what courts have said about payers’ irresponsible medical reviews

  5. Using attachments to make your appeal stronger

 

Go to AppealTraining.com/webinars to register. Webinar registration includes a free 30 day membership at AppealTraining.com where members can access our complete appeal letter database of more than 1600 appeal letter templates.


Contact: Tammy Tipton
Title: President, Appeal Solutions Inc.
Phone: 888-399-4925 ext 703
email: 

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