| Course | MSW 528 Medical Social Work I |
|---|---|
| Week | 6 |
| Paper type | Insurance authorization appeal |
| Length | About 460 words, 4 pages |
| Format | Memo with APA 7 citations |
| School | Chamberlain University |
| Program | Master of Social Work (MSW) |
| Updated | October 2026 |
Free sample paper for MSW 528 Week 6
Memorandum
To: Appeals and Grievances Department, H.'s Medicare Advantage plan
From: Hospital social worker and case manager, on behalf of H. with H.'s written consent
Date: October 8, 2026
Re: Request for expedited reconsideration of denial of inpatient rehabilitation, member ID on file
The Request
We request expedited reconsideration of the plan's October 8 denial of admission to Riverbend Rehabilitation Hospital. Waiting the standard time for a decision could seriously jeopardize H.'s ability to regain maximum function, and we ask for a decision within 72 hours.
The Denial, Quoted
The plan's notice states: "Member's needs can be met in a less intensive setting. Skilled nursing facility level of care is appropriate."
The reason does not cite any coverage criterion. It compares settings, which is not the question the rules ask.
The Standard the Plan Must Apply
Since 2024, plans in Medicare Advantage have been bound by the coverage tests that apply in Traditional Medicare when they decide whether inpatient rehabilitation is medically necessary (Medicare Advantage Policy and Technical Changes, 2023). Those criteria do not ask whether a skilled nursing facility could serve the patient. They ask whether, at admission, the patient requires active and ongoing therapy from multiple disciplines, one of them physical or occupational therapy; can participate in and benefit from an intensive program, generally three hours of therapy daily on at least five days each week; and requires physician supervision and an interdisciplinary approach (Medicare coverage of inpatient rehabilitation, 2025).
H. Meets Each Criterion
Multiple disciplines: physical therapy for gait and stairs, occupational therapy for bathing and left-side inattention, both ordered. Intensive program: H. completed 75 minutes of therapy on October 6 and 90 minutes on October 7, sitting out of bed for four hours a day, and is improving daily. Benefit: H. went from standing with help on October 4 to four steps on October 6; measurable improvement of practical value is expected. Physician supervision: left-side inattention and blood pressure management after stroke require daily physician oversight.
Attached
Therapy notes for October 4 to 7, the neurologist's letter of October 8 and Riverbend's acceptance.
1. Physical therapy notes, October 4 to 7, showing minutes of therapy and progress on standing and stairs.
2. Occupational therapy notes, October 5 to 7, documenting left-side inattention and bathing deficits.
3. The neurologist's letter of October 8 stating the need for daily physician oversight.
4. Riverbend's acceptance, dated October 7.
Contact
Please call the hospital case manager at 555-0172 with the decision. A copy of this request has gone to H.
If no decision arrives within 72 hours, we will contact the plan and, if needed, the independent review entity that handles further Medicare Advantage appeals. H. has asked to be told of the decision the same day it arrives.
References
Medicare Advantage Policy and Technical Changes, 88 Fed. Reg. 22120 (2023).
Medicare coverage of inpatient rehabilitation, 42 C.F.R. ยง 412.622 (2025).
MSW 528 Week 6 instructions, in plain terms
The appeal is a business letter and should look like one. A header carries the member and claim identifiers, the service requested, the date of the denial and the reason printed on it. The first paragraph states the request and its deadline, which is unusual in social work writing and correct here. Quote the plan's denial reason exactly. Then identify the standard the plan must apply and answer it criterion by criterion with dated facts from the record. Do not argue hardship to a reviewer who is checking a rule. Attach evidence and list what is attached rather than describing it. Say who to contact with the decision. The patient's consent to the appeal should be on record.
How the MSW 528 Week 6 example is put together
The memo header addresses the plan's appeals department and notes H.'s written consent. The first section requests expedited reconsideration within 72 hours because waiting could harm recovery. The denial's reason is quoted: needs can be met in a less intensive setting. The standard section cites Medicare Program; Contract Year 2024 Policy and Technical Changes (2023) on plans following Traditional Medicare criteria, then summarizes the criteria in Medicare coverage of inpatient rehabilitation (2025): multiple disciplines, an intensive program, physician supervision. The next section answers each with dated facts, including 75 and 90 minutes of therapy and progress from standing to four steps. Attachments are listed, and a contact line closes the letter.
MSW 528 Week 6 rubric: what full points look like
An appeal that argues hardship to a reader checking a rule gives up the most ground, since every sentence can be true and none addresses the reason for denial. The next deduction is for a denial reason left unquoted. Faculty credit a request and deadline in the opening paragraph, the plan's own words quoted, the governing standard identified and each criterion answered with dated evidence. Listing attachments and a contact shows professionalism. Consent should be noted. Regulations and rules must be cited accurately, in APA legal format. Letters that run long or add emotional appeals the reviewer cannot act on lose marks, and a letter without the member identifiers may not be processed at all.
Common MSW 528 Week 6 mistakes, and how to avoid them
The appeal that loses most tells the patient's story movingly and never mentions the criteria. Another common problem is paraphrasing the denial, which leaves the reviewer unsure what is being contested. Some letters bury the request on the second page or omit the expedited deadline. Others describe medical records instead of attaching them. When the denial in your case concerns something else, perhaps a home health episode or a skilled nursing extension, find the criteria the plan must apply and answer them one by one. An appeal built for your denial will quote the plan's sentence and put a dated fact beside each criterion.
Get a MSW-528 Week 6 example written to your instructions
Send the Week 6 instructions with the denial and case details your section supplies, and a custom appeal letter written to them comes back inside 24 to 48 hours, the first one free. If your classroom wants the attachment list and a supporting clinical summary as well, say so and both arrive with the letter.
More MSW 528 papers and MSW samples
- MSW 528 Week 1: Tow Lot Task Post
- MSW 528 Week 2: Psychosocial Assessment After Stroke
- MSW 528 Week 3: Stroke Unit Rounds Write-Up
- MSW 528 Week 4: Stroke Discharge Plan Draft
- MSW 528 Week 5: Discharge Benefits Eligibility Grid
- MSW 528 Week 7: Safe Discharge Case Analysis
- MSW 528 Week 8: Hospital Practice Reflection
- MSW 529 Week 6: Readmission Case Review
- MSW 526 Week 6: Caseload Hours Analysis Memo
- MSW 525 Week 6: School Coordination Memo for N.
- MSW 524 Week 6: Eviction Intake Screening Script
MSW 528 Week 6 questions, answered
Who signs a letter like this?
Usually not the social worker alone. Appeals of this kind travel over a clinician's signature, or the patient's, or both, and several sections want the write-up to say which and why. Draft it as the document you would hand to the person who signs, and include the release or authorization the plan requires before it will discuss the case with anybody at all.
Can the patient's own words go into it?
A line or two, placed where they support an element of the criterion rather than where they carry the argument. If the rule turns on whether he can manage at home, then his account of reaching the bathroom overnight is evidence and belongs in. Quoted feeling with no criterion underneath it reads as pressure and tends to cost marks in the analysis section.
What if the denial in my case gives no reason?
Then the first letter asks for one, and saying so is a legitimate finished assignment. Request the specific criterion applied and the clinical basis for the decision, cite the plan's own obligation to provide it, and set out what will follow once it arrives. Sections that supply a vague denial are usually testing whether the writer notices there is nothing yet to argue against.
Where can I find a free MSW 528 Week 6 sample paper?
A full MSW 528 Week 6 Medicare Advantage rehabilitation appeal letter is available below, with margin notes on quoting the denial and answering the criteria.
What standard does the MSW 528 Week 6 sample hold the plan to?
Traditional Medicare's inpatient rehabilitation criteria, which Medicare Advantage plans must follow under the 2024 rule, answered one by one with dated therapy facts.