What is an appeal?
What are some reasons why a claim may have been denied but can be appealed? Include 5 examples.
Why is an appeal important?
Is that the next step your friend should take? © BrainMass Inc. brainmass.com March 21, 2019, 9:35 pm ad1c9bdddf
https://brainmass.com/health-sciences/health-care-management/insurance-denials-and-appeal-382152
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Write My Essay For Me!An appeal can be defined as a request to review a decision (Merriam-Webster, 2011). In healthcare, is also an action that the person can take when a claim has been denied, not paid enough, or the health care service rejected by the insurance (Medicare.gov, 2011).
An appeal is a very important asset that the provider or patient has as it provides the opportunity to recuperate payment for services provided. There are certain situations when there will be a need to appeal in writing to the insurance. For example,
A)Denied for wrong diagnosis/modifier/procedure
When the insurance receives a claim, it is automatically review to match
the CPT code provided with the ICD9. If the diagnosis does not support
the procedure, the claim will be automatically rejected. This also
happens when the wrong modifier is used. These claims can be resubmitted
as corrected claims but sometimes the insurance may request to send the
corrected claim as an appeal that will provide additional information
(and a copy of the medical record) that justifies the corrected …
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