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Appealing reimbursement denials. (Practice Management Clinic).

Without the proper equipment, identifying reimbursement denials and filing appeals can be a costly and timeconsuming process. Your office must have an efficient procedure for identifying denials, (1) locating appropriate explanation-of-benefits (EOB) notices for each patient, (2) and responding with an appeal.

With the proper software, your staff can create workfiles for every claim that is denied (figure). Each denied claim can then be reviewed and, if the denial appears to be inappropriate, remedial action can be taken. For example, operative notes, insurance cards, EOB notices, and other information that has been scanned and linked to each patient's account can be sent to the payer along with the letter of appeal. Then the appeal can be tracked just as the initial claim was tracked. (1)

Software technology can be indispensable in helping us navigate the complexities of reimbursement. Successful appeals translate into increased revenue. We simply must utilize the available technology to assist us.


(1.) Isenberg SF. "Campaigns" and "denial workfiles," Ear Nose Throat J 2002;81:504.

(2.) Isenberg SF. Integrated imaging. Ear Nose Throat J 2002;81:768.

Dr. Isenberg is an otolaryngologist in private practice in Indianapolis;
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Article Details
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Author:Isenberg, Steven F.
Publication:Ear, Nose and Throat Journal
Article Type:Brief Article
Geographic Code:1USA
Date:Mar 1, 2003
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