3 Steps That May Prevent an Appeal

Medical Office Billing & Collections Alert 2009

Tip: Don't forget to attach all supporting documentation.

The expression "actions speak louder than words" doesn't apply when it comes to appealing a claim you deserve payment on. Correct and effective wording of your appeal letter is crucial.

Rest assured you've done all you can to win your appeal by adapting this appeal letter template.:

Appeal Letter Template: Procedure With Same-Day E/M Service

Dear [director of claims name here]:

Our claim for E/M service rendered to your covered policy holder [patient name] has been incorrectly denied. An Explanation of Benefits was received on [date] with a denial reason of [denial reason].

[Patient name] presented to our office for an office visit on [date of service]. A patient workup of [history, exam and medical decision-making] was provided, with a finding of [describe finding]. A medically appropriate and necessary [describe diagnostic procedure or surgery] was performed following this finding. Attached, please find documentation to support these services.

Our claim was correctly submitted with CPT Codes [992xx-25] and [procedure code]. This E/M service is not bundled into the global procedure/surgery fee. In fact, the service was a significant, separately identifiable service provided above and beyond the procedure and submitted with the appropriate modifier. Therefore, this appeal is provided to reprocess this claim for immediate payment.

Thank you for your assistance and immediate response.

[Signature line]

Attach: Office visit note
Surgery/Procedure note
Copy of original claim
Copy of EOB