Outpatient Facility Coding Alert - 2019 Issue 12
Reader Question: Follow These Tips for Audit Success
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Article Overview
This reader Q&A discusses how providers can approach appeals after an outside review identifies emergency department claims that were paid incorrectly. It covers general appeal preparation, documentation to include, timing considerations, and the importance of tracking communications with the payer. The piece is aimed at clinicians, billing staff, and coding professionals who handle claim appeals and payer follow-up.
Why This Topic Matters
Understanding a payer’s appeal process and organizing documentation correctly can affect whether an incorrectly paid claim is successfully reviewed and reconsidered.
What You Will Learn
- How to organize an appeal package for a claim that was paid incorrectly
- What types of supporting documentation are commonly used in an appeal
- Why timing and recordkeeping matter in the appeal process
- How to document communications related to a payer appeal
Who Should Read This
- Physicians
- Emergency department billing staff
- Medical coders
- Revenue cycle professionals
- Practice managers
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