Reimbursement

Even if you have coded your claims correctly, health plans might deny, reduce or recode your claims inappropriately.  Appealing such denials is the first step toward obtaining fair reimbursement.  Therefore, physician practices should appeal all inappropriately denied or amended claims.  Here are some sample letters that you can use to appeal inappropriate health plan claims denials:

 


Addendum Offers Guidance on Getting Paid for New Vaccines

From the AAP Department of Practice: Pediatricians should supplement the terms of their third-party payer contracts by negotiating an addendum that addresses payment for new vaccines and vaccine price increases.  The AAP Private Payer Advocacy Advisory Committee drafted a Vaccine Addendum as a guide for pediatricians.  This addendum is meant to provide guidance only on the issue of vaccine payment.  Physicians should consult with their legal counsel on contractual matters.  The addendum includes suggested language to clarify carrier coverage and payment for new vaccines.  In addition, examples of formulas for vaccine payment are provided to clarify rates and to avoid delays in carrier updates to their vaccine payment rates.


For additional information about practice management, please contact:

Laura Blanke, MPH Practice Education Manager
401 West 15th Street, Suite 682
Austin, Texas 78701
(512) 370-1509

Disclaimer: This information is available to provide general education.  It is provided with the understanding that Texas Pediatric Society is not engaged in rendering legal, medical, or other professional services.  Although prepared by professionals, the information provided on this web site should not be utilized as a substitute for professional services.