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. ...
In Audit
Oct 10th, 2012
By Douglas J. Jorgensen, DO, CPC, FACOFP If you disagree with a Medicare payer’s audit findings, you may appeal (see Exclusions on Medicare and Limitations on Payment, 42 C. F. R. Part 405, Subpart I). This is important because if Medicare successfully prosecutes you for fraud, you may face civil monetary penalties of $10,000-$15,000 per ...
Jun 1st, 2012
Let under-utilized appeals systems work for your practice. By Heather M. Shand, CMAA, CBCS, CMB Sometimes, even if you do everything right, you may end up with denied claims. Rather than throw up your hands and walk away, you should appeal. Yes, it will mean extra work, but the results are worth it: Most of ...
In Billing
Feb 25th, 2011
The Centers for Medicare & Medicaid Services (CMS) has revised for 2011 “The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and other Suppliers” brochure. This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians, and other suppliers who provide services and supplies to Medicare ...
May 1st, 2008
By Cheryl Bennett, RN, BS, CPC As a coder, durable medical equipment (DME) may scare you as its coding intricacies are deeply rooted in Healthcare Common Procedure Coding System (HCPCS) Level II codes and Medicare’s policies. Never fear, we’ll show you how to fine-tune your DME coding skills by digging into the DME dirt and ...