Website Makes Health Insurers Pay Claims On-time And In Full

By Author: Wilson Jackson
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How is it that health insurance companies all seem to use similar limitations, exclusions and stall tactics when processing claims? Perhaps because the insurance industry shares ideas that protect and enhance the insurance industry's financial health?

AppealLettersOnline.com was designed to assist the healthcare community share successful appeal information. If you can't beat the carrier at the reimbursement game, now is the time to join AppealLettersOnline.com.

"If someone has an appeal letter that works, wouldn't we all like to read it?" said Tammy Tipton, President of Appeal Solutions, Inc. "Our web repository is the Internet location for medical billers and patient financial representatives to come together as a group and discuss what works and what does not work in curbing and appealing denied claims. If you are an expert at appeals, you now have your own web site."

AppealLettersOnline.com features more than 1600 tried and tested appeal letters posted in order to educate users on how to draft successful appeals. However, the most important aspect of the repository is the opportunity for users to ...
... submit comments on how successful appeal letters have been in their unique setting, in what specific situations they work and to also share appeal letters they have drafted and found to be successful.

"This is an educational resource. I wish we could post a few letters and say 'These work every time in every situation.' Denial management is more complex than that and succeeding at appeals takes a cooperative ongoing educational effort within the industry.

For the first time, there is a site that facilitates and encourages this activity. This is not only a site packed with effective appeal letters; it is a site for in-depth discussion of denials and how to both appeal and avoid them," Tipton said.

Very few healthcare organizations track their denial rate. However, Appeal Solutions has many clients who aggressively appeal denials and track response rates.

The healthcare industry needs a central location to share this information now more than ever. If a hospital, clinical or physician's office is going to stay in good financial health, it simply cannot extend free healthcare, particularly unanticipated free healthcare. That means keeping denials to an absolute minimum, according to industry experts.

Minimizing denials has been the number one goal of Appeal Solutions since 1998 when the company released the first denial management software available - Power of Appeals. Power of Appeals allows healthcare professionals to track denials and respond quickly with professional appeal letters. Denials can also be sorted by denial type and appealed within the system.

Many Power of Appeals users achieve appeal success rates of 70 to 80 percent. Also Power of Appeals users are able to identify trends in denials and changes in processing methods due to reporting and analysis features of the software.

"There is a growing number of professionals who are developing an expertise at appealing denied claims. We hope they will join and share this information for the good of the industry," Tipton said.

AppealLettersOnline.com features a number of forums to allow members to share denial information and to attempt to take the guesswork out of determining which appeals could be successfully resolved and which are more likely non-recoverable. Tipton, who has authored thousands of appeal letters, is an active participant in the forums.

"The more experts, the better," Tipton said. "Nobody wants to reinvent the wheel. No one wants to spend hours on an appeal letter that has already been written. Participation is what makes AppealLettersOnline.com so valuable and we anticipate a very high, very specialized level of participation." To assist users with developing an effective denial management program, AppealLettersOnLine.com also features case studies that offer in-depth discussion on topics from denial prevention to upper level appeals. However, the most innovative feature of AppealLettersOnline.com is its timeliness.

Insurance payment guidelines and rules are ever changing. Healthcare providers must be provided with the means of forming an online community for the purpose of sharing information on the changes, what the effect will be and how best to respond. AppealLettersOnline.com is an in-depth and interactive resource for appeal information.

It is an isolated office's link to many innovative appeal coordinators who face the same challenges in the same setting.
Tammy Tipton is the Founder and President of Appeal Solutions. She is a nationally recognized authority on Denial Management and can be reached at www.appeallettersonline.com.