Overview
Writing an Appeal Letter
Refer to the remittance advice in Figure 4-7 and the sample appeal letter in Figure 4-9 to prepare a letter of appeal based on the case scenario.
Case Scenario: Upon review of the remittance advice in Figure 4-7, identify the reimbursement amount denied by the third-party payer and the reason for the denial. Then, using the sample appeal letter in Figure 4-9, prepare a letter of appeal requesting that the payer review the denied claims for reconsideration. Be sure to indicate in the letter of appeal exactly why the payer should reconsider the claim to provide additional reimbursement. In this case, the reason for reconsideration of the claim is that an “incorrect ICD-10-CM (J45.909) was reported for asthma instead of the code for acute exacerbation of mild intermittent asthma (J45.21); code J45.21 meets medical necessity for CPT service code 99215 (Level 5 office visit). In addition, CPT modifier -25 should have been added to CPT code 99215 to indicate the provision of an unrelated evaluation and management service by the same physician or other qualified health care professional during a post-operative period.”
Writing Requirements
- APA format, 3–4 pages in length (excluding cover page, abstract, and reference list)
- Use the APA template located in the Student Resource Center to complete the assignment.