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Tammy Tipton of Appeals Solutions Inc. On Optimizing Denial Management

Expert Interview Series: Tammy Tipton

Tammy Tipton is President of Appeal Solutions Inc. and the co-author of Power of Appeals Denial Management System. She is also the author of Turning Insurance Denials Into Dollars, a popular denial management manual for both hospital and physicians. She has written extensively on the topic of medical receivables and has frequently lectured on conducting successful appeals and using today’s complex legal system to protect healthcare claim assets. Her company, Appeal Solutions, provides medical claim recovery consulting to hospitals, physicians and billing companies.

Tell us about Appeal Solutions Inc. What services do you offer?
Denial management has become an integral part of the healthcare revenue cycle. With the growing complexity of medical reimbursement, organization must identify, address and analyze each denied and underpaid claim. Appeal Solutions has been on the forefront of providing denial management consulting and products.

What are the challenges of denial management for providers?
The challenges of denial management have multiplied. ICD-10 and value-based reimbursement will have huge impacts on claims processing. Providers must be proactive on dealing with the constant change imposed by outside forces.

Unfortunately, many organizations get mired down by ineffective systems and disconnected personnel who do not have up-to-date denial management resources. We provide answers, solutions and assistance so that a healthcare organization can meet these challenges.

What are the most common mistakes you see providers making with claims management?
Healthcare is among the most highly regulated industries but, too often, healthcare personnel do not use these regulations to their advantage. Our company provides appeal letter templates that cite claim processing regulations and payer-specific guidance so that your appeal will get the attention it merits. We research any change to payment systems and keep current on denial management trends so that you can move forward with an effective approach.

How do you keep your clients educated about the appeals process?
Also, I encourage my clients to share their denial management success stories and provide a platform to highlight healthcare wins. Each month, I publish an article featuring a successful appeal and often assist my clients with getting these stories out in their local specialty publications. These stories keep the ball rolling and encourage others to be better patient advocates in these complicated insurance matters.

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