Book contents
- Observation Medicine
- Observation Medicine
- Copyright page
- Contents
- Advance Praise
- About the Editors
- Contributors
- Foreword: Onward and Upward
- Preface
- Part I Administration: Key Concepts of Observation Medicine, and Developing and Maintaining an Observation Unit
- Part II Observation Medicine: Clinical Setting and Education
- Part III New Developments in Observation Medicine
- Part IV Clinical
- Part V Financial
- Subpart VA Financial – Coding and Reimbursement
- Subpart VB Financial – Case Management
- Subpart VC Financial – Medical Necessity, Denials and Appeals
- Chapter 66 Medical Necessity
- Chapter 67 Denials and Appeals
- Subpart VD Financial – The Business of Observation Medicine
- Part VI International
- Part VII Evidence Basis for Observation Medicine
- Part VIII Clinical Protocols
- Part IX Administrative Policies
- Part X Order Sets
- Prologue
- Index
- References
Chapter 67 - Denials and Appeals
from Subpart VC - Financial – Medical Necessity, Denials and Appeals
Published online by Cambridge University Press: 31 March 2017
Edited by
Book contents
- Observation Medicine
- Observation Medicine
- Copyright page
- Contents
- Advance Praise
- About the Editors
- Contributors
- Foreword: Onward and Upward
- Preface
- Part I Administration: Key Concepts of Observation Medicine, and Developing and Maintaining an Observation Unit
- Part II Observation Medicine: Clinical Setting and Education
- Part III New Developments in Observation Medicine
- Part IV Clinical
- Part V Financial
- Subpart VA Financial – Coding and Reimbursement
- Subpart VB Financial – Case Management
- Subpart VC Financial – Medical Necessity, Denials and Appeals
- Chapter 66 Medical Necessity
- Chapter 67 Denials and Appeals
- Subpart VD Financial – The Business of Observation Medicine
- Part VI International
- Part VII Evidence Basis for Observation Medicine
- Part VIII Clinical Protocols
- Part IX Administrative Policies
- Part X Order Sets
- Prologue
- Index
- References
Summary
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- Observation MedicinePrinciples and Protocols, pp. 378 - 381Publisher: Cambridge University PressPrint publication year: 2017
References
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Cigna HealthCare Reference Guide, TriState Region, 801759g; 7/2011.Google Scholar
Request for Payment Review and Appeal Form, Cigna Corporation, 2011.Google Scholar
Appeal that Claim, Take an Active Approach to the Claims Revenue Cycle, AMA Practice Management Center, Kristie L. Martinez, CMM, CCS-P, American Medical Association, 2011.Google Scholar
New York State, Department of Financial Services, External Appeals, 2012.Google Scholar
New York State Insurance Law, Article 49.Google Scholar
Olaniyan, O; Brown, I; Williams, K. Managing Medical Necessity and Notification Denials, Healthcare Financial Management, 63.8 (2009), Aug;63(8);62–67.Google ScholarPubMed
The Medicare Appeals Process, Five Levels to Protect Providers, Physicians, and Other Suppliers, Department of Health and Human Services, Centers for Medicare and Medicaid Services, January 2011.Google Scholar
Statement of the American Medical Association to the Institute of Medicine’s Committee on Determination of Essential Health Benefits. January 14, 2011. http://iom.nationalacademies.org/~/media/8D03963CAEB24450947C1AEC0CAECD85.ashx (Accessed February 20, 2016)Google Scholar
How to Prepare a Winning RAC Appeal, Craneware InSight Consulting, 2011.Google Scholar
Brown, R, Lagorio, N et al. Mistaken Admission: Establishing Medical Necessity for Inpatient Procedures, CAN Health Pro, Chicago, IL, March 2009.Google Scholar
Moore, K. Navigating the Patient Appeals Process, Fam Pract Manag. 2000, Oct;7(9);43–46.Google Scholar