Practices should be diligent about appealing inappropriate denials (eg, services inappropriately bundled, nonrecognition of modifiers) or incorrect payments (eg, payment reduced, services denied). By not appealing, practices lose revenue and allow payers to misuse Current Procedural Terminology and International Classification of Diseases, Ninth Revision, Clinical Modification guidelines.

Before appealing any claim, make certain that the appeal is within the payer’s time guidelines and that you follow its appeals process.

The American Academy of Pediatrics (AAP) has an extensive list of template appeal letters that address services that are commonly denied or bundled. Included are letters addressing bundling of circumcisions with an evaluation and management (E/M) service, requiring modifier 25 when reporting immunization administration with an E/M service, payment for influenza A and B when performed on the same day of service, and bundling of problem-oriented visits with preventive medicine visits. These letters can be accessed on the AAP Practice Management...

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