Assignment-Ch.16 Compose an Appeal Letter Using Fordney Insurance Handbook Chapter 16 ” Receiving Payments and Insurance Problem Solving Scenario: Use Mary T. Avery’s insurance claim in

Assignment-Ch.16 Compose an Appeal Letter
Using Fordney Insurance Handbook Chapter 16 ” Receiving Payments and Insurance Problem Solving

Scenario: Use Mary T. Avery’s insurance claim in Assignment (see Fig. 16.6), the insurance company sends an EOB/RA (health insurance claim number 123098) with a check in the amount of $300 to the College Clinic for payment of the claim. Dr. Cutler wishes an appeal to be made for an increase of the payment of an additional $100. (Note: This patient’s marital status is single, and the insured’s identification number is T45098.)

Directions: Use the claim to Assignment Fig.16.6 for Mary T. Avery. Follow these basic step-by-step procedures

1. Compose, format, proofread, and submit your appeal letter on a Word Document as your assignment.

2. Include the beneficiary’s name, health insurance claim number, dates of service in question, and items or services in question with name, address, and signature of the provider.

3. Compose a letter with an introduction that stresses the medical practice’s qualifications, the physician’s commitment to complying with regulations and providing appropriate services, and the importance of the practice to the payer’s panel of physicians or specialists.

4. Provide a detailed account of the necessity of the treatment given and its relationship to the patient’s problems and chief complaint. You might cross-reference the medical record and emphasize parts of it that the reviewer may have missed.

5. Explain the reason why the provider does not agree with the payment.

6. Abstract excerpts from the coding resource book if necessary.

7. Direct the correspondence to Mr. Donald Pearson, a claims adjuster at the American Insurance Company, 509 Main Street, Woodland Hills, XY 12345.

8. Retain copies of all data sent for the physician’s files.