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Appeal Letters
Often claims are denied because of improper bundling issues implemented by insurance carriers or lack of education in the claims processing department of the carrier. These improperly denied claims must be appealed to the carrier for proper reimbursement.
The AUA has developed a series of letters to assist urology offices with documentation of appropriate billing of urological procedures and aid in the appeals process for reimbursement. Appeal letters from the AUA have provided guidance and education for proper reimbursement and have proved successful in the appeals process.
Appeal letters are available for:
Clinical Appeals
Administrative Appeals
The AUA Offers Help When Filing An Administrative Appeal
The average medical practice today has experienced a noticeable increase in administrative denials that are not based on coding or improper filing errors. Pre-certification requirements, managed care, medical necessity, coverage exclusions, duplicate submissions and timely filing are some of the many administrative denials medical professionals encounter when seeking reimbursement. An effective appeal letter should cite state statutes or case law to support the reconsideration request. To find the applicable laws visit the web site of your state insurance commission or this area of our site. It is imperative that your practice doesn't base an appeal only on an insurer's contract or billing guidelines but also on the regulatory environment that the payer must exist under. If you still need help in composing an effective appeal letter click on the menu below. For help with clinical appeals see above.
CPT® is a registered trademark of the American Medical Association.
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