Create Account | Sign In: Author or Forum

Search Symptoms

Category: Cardiology | Dermatology | Endocrinology | Family Medicine | Geriatrics | Gastroenterology | Gynecology | Infections | AIDS | Internal Medicine | Allergy | Critical Care | Emergency Medicine | Nephrology | Neurology | Nursing | Oncology | Ophthalmology | Orthopedics | ENT | Pathology | Pediatrics | Pharmacy | Psychiatry | Pulmonology | Radiology | Rheumatology | Surgery | Anesthesiology & Pain | Urology | Journal

Back to Journal Articles

Experts Offer Tips for Provider Appeal of Denied Medical Claims

Last Updated: August 20, 2018.

Knowing payer policies and regulatory requirements is critical to appealing denials, according to an article published in Medical Economics.

MONDAY, Aug.20, 2018 (HealthDay News) -- Knowing payer policies and regulatory requirements is critical to appealing denials, according to an article published in Medical Economics.

Michael Strong, a bill review technical specialist at SFM Mutual Insurance Co. in Bloomington, Minn., and Tammy Tipton, owner of Appeal Solutions Inc. in Oklahoma City, suggest several tips to ease the appeal process.

First, Strong says, look at the remark codes and address those specific edits, including documentation of lab or operative reports. Ask for exceptions to payer policies in the cases of atypical patient presentation or pediatric patients, Tipton advises. In addition, she says to cite regulatory information in the appeal letter, including Medicare Local Coverage Determinations and National Coverage Determinations, the Affordable Care Act and its expanded access to external reviews, and the Employee Retirement Income Security Act, which allows providers with authorization to appeal on a patient's behalf.

"Being smarter than your payers is the key to successful denial management," Strong said in the article.

More Information


Previous: Physicians Rate Communication During Visit Lower Than Patients Next: NYU Becomes First Medical School to Cover All Tuition

Reader comments on this article are listed below. Review our comments policy.


Submit your opinion: