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Putting together an appeal of a denied claim isn't anyone's idea of a good time, but at least APTA is making the process a little easier.

Now available to APTA members: customizable template letters that help make the case for payment. The letters target 3 types of denials:

Denials related to change in practice location. This letter is crafted to address a Medicare Administrative Contractor's (MAC) denial of payment based on an erroneous conclusion that the provider didn't give sufficient notice of a change in practice location.

Denials related to the use of the 59 modifier. The template, applicable to both MAC and private insurer denials, helps make the case for valid use of the 59 modifier, used to represent a service that is separate and distinct from another service it's paired with.

Denials related to medical necessity. Also usable in both Medicare and private insurance-related appeals, this letter helps a member articulate why services were in fact medically necessary.

The templates, offered in Word, include directions for inserting crucial patient and treatment details to strengthen the appeal argument. All 3 letters are available on APTA's Medicare Denials, Audits, and Appeals webpage; the 2 letters applicable to private insurers also can be found on the association's Commercial Insurance webpage, along with a general appeal letter outline.


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