If a private payer inappropriately denies or bundles a procedure or service that you furnished, here are some steps to follow:
Contacting Medical Directors: Article addressing factors to consider before discussing coverage decisions with medical directors
Medical Policies: Websites for the medical policies for national private payers
News and Updates: Includes important updates on coverage policies for national private payers
Appeal Template letters: Sample letters to assist with denials
American Medical Association (AMA): The AMA has established a very useful third party payer advocacy department that you can report coverage problems. If you are interested in filing a complaint against an insurer, you can visit the AMA practice management center to obtain details on this process specific to the state where your practice is located.
Medical Group Management Association (MGMA): Practice management resources from the MGMA
Association of Otolaryngology Administrators (AOA): Practice management resources from the AOA
Workshops held in cities nationwide will help otolaryngologists, their staff, and other healthcare professionals code correctly, learn risk reduction strategies, and organize business systems.