Writing Successful Appeals and Understanding the Appeals Process

Recorded Webinar | Lynn Anderanin | From: Nov 24, 2021 - To: Dec 31, 2021

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Recording
   $99  
DVD
   $109  
Recording + DVD
   $209  
Transcript (Pdf)
   $99  
Recording & Transcript (Pdf)
   $199  
DVD & Transcript (Pdf)
   $209  


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Part of the revenue cycle process is the submission of clean claims to the insurance carriers for timely processing and reimbursement. Unfortunately, there are circumstances when insurance companies, whether right or wrong, will deny a claim or claim line. To receive the reimbursement expected when a claim has been denied in error, most insurance companies require an appeal be submitted for reconsideration of the denial. These appeals must be thorough and explain in detail why the claim should be reimbursed, and the documentation to support the service or procedure should be also submitted to be reviewed by the insurance company. Even in some circumstances, a second-level appeal will need to be submitted. This webinar will explain common denials and the reason codes which should be used by all insurance companies based on HIPAA guidelines as well as what should be included or excluded in your appeals. We will also discuss easy tips on making your appeals as relevant as possible for easy acceptance by the insurance companies.

Learning Objectives:-

  • Use denial and remark codes to understand the reason why a claim was denied
  • Capture the appropriate documentation to support why the denial is incorrect
  • Share with the insurance company what other information is needed for reconsideration
  • Create an effective appeal by explaining the circumstances in coding language
  • Help the reviewer by sharing as much information as possible for easy acceptance
  • Know what forms/formats are needed for a specific insurance company
  • Realize the methods of submitting appeals to insurance companies
  • Use the 2nd level appeal process when necessary
  • Understand what can be done when an appeal denial has been received.

Areas Covered in the Session:-

  • Finding and understanding denial and remark codes
  • Common denials and how they will need to be reconciled
  • NCCI policies that create denials
  • Understanding each insurance company’s appeals process
  • The appeals process
  • Writing an effective appeal
  • What should be documentation should be submitted
  • Knowing what to do when an appeal is not enough

Who Should Attend:-

  • Billers
  • Coders
  • Claims Adjusters
  • Claims processors
  • Physicians
  • Nurses
  • Physicians Assistants
  • Scribes
  • Managers
  • Administrator
  • Insurance collectors

Lynn Anderanin

Lynn Anderanin, CPC, CPPM, CPC-I, COSC is the Sr. Director Coding Compliance and Education for Healthcare Information Services, a physician billing and consulting service in the Chicago area.

  • Lynn has over 30 years experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations.
  • Lynn's experience is primarily in the specialties of Orthopedics, Rheumatology, and Hematology/Oncology.
  • She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, audio conferences, and Local Chapters.
  • Lynn became a CPC in 1993, a Certified Instructor in 2002, and a Certified Orthopedic Surgery Coder in 2009.
  • She is the founder of the first local Chapter of the AAPC in Chicago, which is now 16 years old, and a former member of the AAPC National Advisory Board as well as other Committees for the AAPC.