Writing Effective Appeals for Orthopedic Denials

Why Should You Attend:

When insurance carriers have not processed claims according to the guidelines it is essential to have the tools to effectively communicate with the insurance carriers for proper reimbursement. Often insurance carriers claims processing systems do not properly process modifiers used on claims to accurately describe specific situations related to a surgery on a case by case basis.

This webinar will discuss specific issues related to orthopedic claims and what works in adjudicating payments from the insurance carriers. The orthopedic anatomy will be reviewed for a better understanding of CPT’s intent on the use of many of the most common orthopaedic surgical cases. We will discuss common errors in claims processing and attendees will receive sample appeals letters to utilize in their office for the most frequently received orthopaedic denials. The references that should be used in addition to the appeal will also be shared for more effective appeals. CMS created NCCI Edits and Medically Unlikely Edits will also be described, as many insurance carriers apply these edits to claims processing for proper coding.

The presenter will provide helpful hints on other tricks to get your appeals noticed, and the process of tracking appeals, based on a proven system currently being used, for efficiency and results.

Areas Covered in the Webinar:

• What should be included in an affective appeal letter
• What documentation should be included in your appeal
• Tips on what to do when insurance carriers are not recognizing modifiers
• What reimbursement should be received on add on codes and tools to correspond with insurance carriers
• Follow up process on appeals
• Suggestions to track appeals payments

Who will Benefit:

This webinar will provide valuable assistance to all providers who perform surgery with global surgical packages of 10 or 90 days. The individuals who will benefit include:

• Physicians
• Physician Coders
• Reimbursement staff in the back office
• Office Administrators and Financial Staff

Instructor Profile:

Lynn Anderanin, CPC,CPC-I, COSC is the Sr. Director Coding Compliance and Education for Healthcare Information Services, a physician billing and consulting service in the Chicagoland, area. She has over 30 years experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, audio conferences, and Local Chapters. Lynn became a CPC in 1993, and a Certified Instructor in 2002, and a Certified Orthopedic Surgery Coder in 2009. Lynn is the founder of the first local Chapter of the AAPC in Chicago, which is now 16 years old, and a former member of the AAPC National Advisory Board as well as other Committees for the AAPC.

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