Draft an effective denied-claim appeal letter

When drafting an appeal letter for a denied claim, start with an introductory section that stresses your practice's qualifications and your commitment to compliance and providing appropriate services. Then, offer a detailed account of the treatment provided to the patient in question. Cross-reference the medical record. Use this as your opportunity to walk the reviewer through the parts of the medical record that you want to emphasize or that you think he or she might miss.

The rest of the letter should address the following points:

  • The patient's medical history
  • Complaints on the date of the visit
  • Necessity of the treatment and its relation to the historical problems and chief complaint
  • Compliance of treatment with accepted treatment patterns
  • Benefits of treatment to the patient

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Reed Tinsley, CPA