About This Site    Contact Us    Help   
SEARCH
 
Sign In
   < Back
Special Feature:
Template Letters on Practice Issues
The American Academy of Pediatrics has developed a collection of template letters that your practice can use or adapt for your practice, including letters to health plan medical directors outlining appropriate coding and payment guidance

Jump down to:
- Letters to Patients
- Letters to Carriers

Letters to PatientsBack to top
Patient Denial Letter

Sample letter to patients outlining circumstances that led to the denial of their request to inspect and copy their protected health information, one of a collection of documents designed to assist your practice in setting up appropriate policies and procedures to comply with the HIPAA Privacy Rule.

Request to Inspect and Copy Protected Health Information

Sample request form for patients who wish to inspect and copy their protected health information, one of a collection of documents designed to assist your practice in setting up appropriate policies and procedures to comply with the HIPAA Privacy Rule.

Template Letter to Parents: Unable to Provide Gardasil

This template letter to patients/families regarding the physician's inability to provide Gardasil to their child due to the high vaccine costs.

Template Letter: Physicians Electing Not to Sign the Proposed Contract

Template letter to provide to parents/families advising them that pediatrician is no longer a network provider.

Template Letter: Retail-based Clinics Letter to Patients

Template letter to inform patients when a retail-based clinic (RBC) will be opening in the area. This letter can also be modified, so it is appropriate to send to patients who have already been seen at an RBC.

Template Letter: Unable to Continue Medical Care

Template letter to patients/families regarding the physician's inability to provide continued medical care to them/their child.

Tool D: Sample Patient Notification Letter Version 1

Template letter to patients/families alerting them that providing telephone care is an option of the practice and is a billable service. This is part of the AAP's Payment for Telephone Care: A Toolkit.

Tool E: Sample Patient Notification Letter Version 2

Template letter to patients/families alerting them that providing telephone care is an option of the practice and is a billable service. This is part of the AAP's Payment for Telephone Care: A Toolkit.

Tool F: Sample Patient Notification Letter Version 3

Template letter to patients/families alerting them that providing telephone care is an option of the practice and is a billable service. This is part of the AAP's Payment for Telephone Care: A Toolkit.

Letters to CarriersBack to top
Template Letter: Appeal to Payers for Payment

Template letter to insurance carriers appealing insurance companies refusal to make payment.

Template Letter: Bundling Circumcision and Administration of Nerve Block

Template letter to insurance carriers regarding the practice of bundling the administration of penile nerve block with circumcision.

Template Letter: Bundling Circumcision and E/M Services

Template letter to insurance carriers regarding the practice of bundling the evaluation and management service with circumcision.

Template Letter: Bundling Immunization Administration with Vaccine Product Reimbursement

Template letter to insurance carriers regarding the practice of bundling immunization administration with vaccine product reimbursement.

Template Letter: Bundling Obesity Evaluation and Treatment

Sample carrier letter regarding the bundling of services related to obesity evaluation and treatment.

Template Letter: Bundling Preventive Medicine and Office/Outpatient Service Codes

Template letter to insurance carriers regarding the practice of bundling preventive medicine service codes and office/outpatient service codes.

Template Letter: Bundling Vision Screens with Preventive Medicine Service Codes

Template letter to insurance carriers regarding the practice of bundling vision screening with the preventive medicine service codes.

Template Letter: Denying Coverage for Hourly Critical Care Codes

Template letter to insurance carriers regarding the denial of coverage for hourly critical care codes (CPT codes 99291-99292).

Template Letter: Denying or Reducing Reimbursement for Immunization Administration

Template letter to insurance carriers regarding the practice of denying or reducing the reimbursement amount for CPT code 90472 (immunization administration; each additional vaccine).

Template Letter: Downcoding E/M or Consult Service

Template letter to insurance carriers regarding the inappropriate downcoding of CPT codes.

Template Letter: Insurance Carriers Unable to Provide Gardasil

Template letter to insurance carriers regarding the physician's inability to provide Gardasil to their patients unless payment increases.

Template Letter: Modifier -25

Template letter to insurance carriers regarding the misinterpretation of modifier -25.

Template Letter: Retrospective Audits and Take Back Demands

Insurers are sending letters to providers alleging improper billing and significant overpayments. Read this to find out what you can do if you receive a "take back demand" from a carrier.

Tool J: Sample Payer Notification Letter

Template letter to carriers alerting them of charging for telephone visits. This is part of the AAP's Payment for Telephone Care: A Toolkit.

Tool P: Sample Appeal Letter to Payer

Template letter to payer regarding denial of previous claim. This is part of the AAP's Payment for Telephone Care: A Toolkit.

Click to view other special features
Newsletters Resources
Manuals Documents and Tools
Peer Discussions



©2008 COPYRIGHT AMERICAN ACADEMY OF PEDIATRICS, ALL RIGHTS RESERVED Site map | Contact us | Privacy statement | About us | Home
American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL, 60007, 847-434-4000
Use of this Web site signifies acceptance of our Terms of Use