Whether it is a Part A or Part B hearing, the issue is always the same: should the provider/supplier be paid for denied service? Unless the Administrative Law Judge (ALJ) understands the patient's problem, understands what was done for the problem, and agrees what was done was the correct thing to do for the problem – the ALJ will not award payment. The need for an explanation of the above in plain English is vital for both providers and suppliers.
Unfortunately, however, most providers and suppliers still submit medical records to the QIC without adequate explanation or organization. By contrast, and as a result of this webcast, the ALJ team assigned to your claim(s) will welcome your less-than-three-pages -in-length letter. Your letter brief will allow you to tell the ALJ team, without interruption or opposition, why payment should be ordered, allowing you to spend valuable hearing time telling the ALJ the patient's "story" instead of wasting hearing time with a list of boring clinical facts.
This exclusive RACmonitor webcast will address the structure and content of the letter brief and the use of patient care documents, photos, articles, textbook sections, and standard of care policy statements as attachments. You need a formula approach that enables you to write an effective letter brief. David Mullens, author of the upcoming book "How To Win Medicare Appeals," provides that formula approach.
Why This is Relevant:
Seema Verma, the CMS Administrator wrote in November of 2018: "The 2018 Medicare Fee-For-Service improper payment rate is the lowest since 2010. The decreased improper payment rate from 2017 to 2018 represents a $4.59 billion drop in estimated improper payments." Who is being squeezed as CMS tightens the Medicare payment rules? Look in the mirror.
As a result of attending this RACmonitor webcast led by attorney David Mullens, JD, DPM you and your team will…
- Know why you must always submit a letter brief to QIC;
- Learn what the letter brief should include;
- Know what the letter brief should not include;
- Learn how to structure the contents of the letter brief and the attachments to the letter brief; and
- Know how to construct a formula approach to writing your letter briefs.
Who Should Attend:
Those who will gain the most from this webcast are physicians, billing offices and departments, appeal specialists and coordinators, plus attorney representatives.