• A
  • |
  • A
  • Text size

Appeal that Claim

"Sometimes one letter is all it takes," said Jan Faibisoff, MD, an AMA member from Illinois. And he should know. He collected at least $10,000 more in claims by appealing denials with the AMA's "Appeal that Claim" letter templates.

One practice in Chicago recovered $19,000 over 6 months from appealing a single type of underpaid claim.

Within five months of implementing an effective auditing and appeal process, one practice in Chicago was already recovering as much as $100,000 per month.

Claims Workflow Assistant

With this free tool, you can look up the reasons health insurers reported for denying claims on the electronic remittance advices (ERAs) you receive.  Then, you can determine the best steps for your practice to reverse the denial.  The tool even helps you get started with recommended workflows for top denials and provides numerous template appeal letters that AMA members can easily modify to use in their practices.

Access this resource

Sample appeal letters

View sample claims management letters for the physician practice. As a benefit of membership, AMA members can download these sample letters as Word files to modify and customize in their practices.

AMA members can also access the National Managed Care Contract Database, where they can look up state laws and regulations to copy and paste into their appeal letters.

Authorization & eligibility

Contractual obligation

Medical necessity

Payer-applied edits

Prompt Payment

General 

Overpayment Recovery Toolkit

Attempting to determine the validity of alleged overpayments can divert significant time from direct patient care, which results in lost practice revenue. Overpayment demands may be made in very general terms and may also be intimidating. Such amounts are frequently the result of “extrapolated” audits. The AMA Overpayment Recovery Toolkit provides steps your practice can take to challenge inappropriate overpayment recovery requests.

Access this resource

LinkedIn Discussion Group
Join discussions in the AMA Administrative Simplification LinkedIn Group.