Creating Effective Appeals

This comprehensive webinar provides a roadmap for healthcare professionals navigating the often complex and frustrating world of insurance denials and appeals. With denials on the rise and payer policies becoming more stringent, understanding how to craft and submit a compelling appeal is more critical than ever. The session covers the structure and content of effective appeal letters, including what documentation to include, the hierarchy of references to support medical necessity, and real-life appeal examples. Participants will gain insight into national coding policies such as the NCCI edits, Medically Unlikely Edits (MUEs), and correct application of modifiers including 22 and 25. The course also discusses payer-specific changes like Cigna’s modifier 25 documentation requirements, best practices for handling unlisted and add-on CPT codes, and how to respond when appeals are denied at the first level. A practical approach to trending denials, improving internal processes, and escalating unresolved claims to second-level reviews and state insurance commissions will be presented. This webinar is ideal for professionals seeking to enhance their appeals process, reduce revenue loss, and improve compliance and reimbursement outcomes.

Webinar Objectives

This session will address how to respond to common denial types, such as those involving modifier 25, multiple procedure discounts, or unlisted procedures. It provides strategies and documentation tips for creating effective first- and second-level appeals, including what resources to cite and how to leverage your practice’s fee schedule and contracts. The session aims to empower attendees to improve claim outcomes and minimize revenue loss through precise appeal language, clinical documentation, and payer-specific strategies.

Webinar Agenda

• Introduction to the appeals process and types of denials
• Building a strong appeal: documentation, hierarchy of references, and sample letters
• Understanding NCCI edits, MUEs, and MAI indicators
• Payer-specific policy changes and how to respond (e.g., Cigna's modifier 25 requirement)
• Reimbursement pitfalls: modifier 22, add-on codes, unlisted codes, and contract compliance
• Denial tracking: identifying trends and improving internal processes
• Next-level strategies: peer-to-peer review, second-level appeal, and state commissioners
• Q&A session and final tips

Webinar Highlights

• How to structure an appeal letter that gets results
• Understanding NCCI and MUE edits and when to challenge them
• Using proper documentation to support modifier 22 and 25 usage
• Addressing common payer policies and new trends, like Cigna's changes
• Tactics for appealing underpayment of add-on and unlisted CPT codes
• Creating coding policies to prevent denials on future claims
• How to track and trend denials by carrier, CPT, and diagnosis code
• Using contracts and fee schedules to appeal based on reimbursement agreements
• How to elevate appeals to state insurance commissioners if needed

Who Should Attend

Medical coders, billers, revenue cycle managers, practice administrators, compliance officers, and appeals specialists.