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Claim Denials: Steps to Writing an Effective Appeal Letter

Writing an effective appeal letter to contest a denied claim involves time, effort and perseverance. The strategic approach of formulating the appeal letter requires a clear understanding of why the claim was rejected. The reason for the denial is the starting point. Considering this, thoroughly review the medical record within the denied claim period and tab the documents needed to support the claim. The Body of the Appeal Letter Begin the appeal letter with the patient’s…

Will Your Therapy Documentation Survive an Audit?

In 2020 there was a lull in Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) requesting medical records for audits through August 2020. Audits have resumed, including audits under the Targeted, Probe, and Educate (TPE) process. The most recent TPE focus involves Medicare Part B review of therapy claims billing CPT codes 97530 (therapeutic activities) and 97110 (therapeutic exercises) and Medicare Part A skilled nursing claims from 2017 through 2019 with admitting diagnoses of…

F-Tags in Review: F550 Resident Rights

F-Tag 550 covers several different segments of resident rights. When you think about responsibilities and focus areas for skilled nursing facility (SNF) staff, resident rights should be the first thing that comes to mind. Let’s look at what is outlined in the different segments. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. Caregivers in long-term care must keep the residents’ best…