There is no reason to ever write an appeal letter from scratch. You will never write just one appeal for chest pain or knee replacement surgery. Denials come in multiples. The only difference from the first chest pain denial and the twentieth is the circumstances of the patient.
Evidence based guidelines support the standards of care in the medical community. These guidelines describe the reasons for admission of patients presenting with chest pain, and they don’t change from patient to patient. While the standards of care may change over time, which is one reason why your library is never finished, the standards of care do not change based on the patient or the payer.
One of the first lessons I learned as an appeal writer was using an appeal letter template would save me a lot of time, effort and frustration. As I watched the pile of denials and medical records on my desk grow at a rapid rate, I knew a well-written appeals template would help me do more and win more appeals. I’m not talking about a one-page Word document that has a place for a header, a salutation, and a closer. I’m talking about a full fledged template that includes fields for all vital patient information, required whenever you file an appeal.
Further, an effective appeal template includes:
- The patient narrative
- Arguments around medical necessity
- Coding criteria
- Regulatory or payment citations
- Any other information that leads to a compelling argument for payment.
This leads to a decision in our favor.
Creating appeal letter templates is not an easy task. It is time consuming and requires research and experience in appeal writing. Creating an appeal letter template library is work that has a beginning, but never an end. Templates must be reviewed, updated, recreated, appended and adjusted to maintain the relevance and effectiveness of the arguments. Yet, having an appeal letter template library is so worth it. The time and effort you can save in the work of appeal writing is invaluable.
Begin with your most frequently denied issues. These are typically those short-stay inpatient admissions that enter through the ED: chest pain, syncope, heart failure, TIA. What arguments have been successful in overturning these denials? Start with a letter that was successful and go from there. Do the research to determine the standard of care in the community and include that in your template. Just use the three or four sentences from evidence based medicine that support the medical necessity of admission or procedure. Do that for every new issue that comes across your desk and eventually you will have built a library of resources.
An appeal template library can transform your work from overwhelming to winning. How have you approached the development of your appeal letter template library?
