Communication is essential to a smooth appeals process. Your practice was the subject of a special investigation unit (SIU) audit, and now the payer is asking for a refund. You have two choices: pay or appeal. If you disagree with the findings, the smart choice is to meet with the payer, appeal the findings, and ...
In Billing
Dec 19th, 2016
Provider agreements (or the ancillary documents) outline the formal processes to appeal payers’ payment decisions. You must review your agreement (or ancillary documents) with the specific payer to comply with the rules of the appeal process. A meritorious appeal may fail because you didn’t meet deadlines, follow the outlined procedures, or provide the necessary information. ...
Dec 9th, 2015
Medicare claims processing systems contain edits that identify exact duplicate claims and suspect duplicate claims. Duplicate claims are counterproductive and costly, and they can get you into hot water with your Medicare administrative contractor (MAC): Too many billing errors (of any nature) may result in your MAC imposing program integrity actions against your practice. So ...
In Billing
Sep 11th, 2014
What do you do when an error on a claim is discovered by someone in your practice after the claim has been processed? According to National Government Services (NGS), many physician practices correct such claims and then resubmit them. The problem with doing this is that these claims have already been finalized – thus, these resubmitted claims ...
Part 3: Learn how to appeal appropriately. By  Dennis Mihale, MD, MBA; Jeremy P. Burnette, JD, MA; and Sidney Summers Welch, JD, MPH Being audited is serious business. If you think there is an error with the payer’s findings, you have a right to appeal the decision and should do so, as appropriate. But you’ll need to ...