< Back 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. Find more Documents & Forms in the Practice Toolbox Jump down to: - Letters to Patients - Letters to Carriers Letters to Patients Back 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: Applied to Medicaid Program Template letter to patients/families regarding the office policy on handling pending Medicaid applications. Template Letter to Parents: Changes in Deductible Template letter to patients/families regarding the decrease in employer-sponsored health coverage resulting in increased co-payments and deductibles. Template Letter to Parents: Families Without Health Insurance Template letter to patients/families without health insurance about payment options. Template Letter to Parents: Outstanding Patient Account Balance Letter Template letter to patients/families alerting them of an outstanding patient account balances. Template Letter to Parents: Patient Letter Responding to Questionable Bill Template letter to update a patients after they have questioned a bill. 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 to Parents: Welcome New Patient Letter Template letter to patients/families welcoming them to the practice. Template Letter: Closing or Retiring from Practice Template letter to patients/families regarding the physician's retirement or closing of a practice. Template Letter: Patient Discharge Letter Template letter to patients/families regarding the physician's inability to provide continued medical care to them/their child. 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. 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 Carriers Back to top Denial Management and Contract Negotiation for Obesity Services Private carriers may have health plans that do not cover obesity-related services under the medical plan; they may be carved out of the benefits package completely or part of a disease management program. This article provides strategies to enhance coverage, and negotiation techniques. A template letter is also provided. 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.