When appealing coverage decisions – Ophthalmic Professional

Someone in your billing staff approaches you with a letter from one of your most important insurers asking for money back (also known as “recoupment”). You look over the payer’s letter and the first chart in the list — the payer has a problem with a surgery they paid you for about 18 months ago.

All seems in order when you look at the chart by itself, but after carefully reading the policy, you note that you could have worded some things differently in your chart to help the payer see your side of things. The biller also tells you this insurer asked for a number of records about six months ago and that this was one of the services audited for this patient. What should you do next?

This article addresses the following topics:

Assemble the chart
Collect the payer policy
Draft a rebuttal letter
Get the information to the payer

This article was published in Ophthalmic Professional’s Coding column, and written by Corcoran’s Senior Consultant, Paul Larson, COE. To view the entire article in Ophthalmic Professional, click on the link below:


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