Medicare Compliance & Reimbursement

If your appeals seem to be stuck in traffic, you may be sending them in the wrong direction, suggests one Medicare Administrative Contractor (MAC).

In a recent alert, Part B MAC WPS-GHA suggests that some providers are causing their own appeals’ delays or dismissals by confusing their level of appeals and sending documentation to the wrong location. “Before sending your appeals request, verify which contractor completes the level of appeal,” WPS-GHA advises. “Is it the Medicare Administrative Contractor (MAC) or Qualified Independent Contractor (QIC)?”

Providers should send their redeterminations (level one of Medicare appeals) to the MAC completing the claims processing, WPS-GHA reminds.

However, “if you disagree with the level one decision, submit a level two appeal (reconsideration). Do not send a level two appeal request to the MAC,” urges the Medicare carrier. This request must go to the QIC.

Review the WPS-GHA alert at www.wpsgha.com/wps/portal/mac/site/appeals/news-and-updates/appeals-delays-dismissals.