Template Appeal Letters and Advocacy Statements
In order to assist with your reimbursement needs the Academy of Otolaryngology—Head and Neck Surgery has created template letters advocacy statements (otherwise known as blanket statements) to assist members with denials on specific procedures.
- Modifier 22 (unusual procedural services) Template Letter (2007)
- Modifier 25 (significant, seperately identifiable E/M service by the same physician on the same DOS) Template Letter (2007)
- Academy Advocacy Statement for E-M and Modifier -25 (2012)
- Unlisted Procedure Template Letter (2007)
- Patient Notification Template (2011)
The Academy's Health Policy team advocates on national socioeconomic issues impacting the membership at-large in an effort to optimize reimbursement, mitigate adverse policy decisions, and improve relationships between members and payers both in the public and private sectors. While our primary focus is to address national issues, we also remain committed to providing members with the needed support to address issues that are more isolated at the local or state level, particularly if members across numerous states experience similar grievances, or if a policy runs counter to an Academy position, correct coding initiative, or the like.
We have created template appeal letters and to assist members with denials on specific procedures by local payers. While the letters are generic, act only as guidance for you to construct your appeal letters, and do not purport to address the details of your appeal, they have been crafted to maximize the opportunity for positive results when members correspond with local payers. Members should use their company letterhead/logo as well as fill in the blanks and header information. Our advocacy statements have been created to offer additional support and a detailed rationale of why a particular procedure should be covered by payers.
Please Contact the Health Policy department if you have any questions regarding these letters.