by Knicole C. Emanuel Esq.
Medicare providers are your claims clean?
Federal regulations mandate that 90 percent of “clean claims” must be paid to healthcare providers within 30 days. But what if the payor doesn’t pay within 30 days? What if your claims are unclean?
The problem is – who determines what a clean claim is? Your payer? Your MAC (Medicare Administrative Contractor)? If you bill 100 claims and are paid for 50, because 50 are denied as not being “clean,” how do you know whether the denied ones were actually unclean?
Then, if you disagree with whoever’s determination it is that says your claims aren’t clean, where do you appeal that decision? Can you appeal? The answer is often no. In an egregious case, you could litigate, and argue that the MAC (or whomever) is not doing their job properly.
This article originally published on May 4, 2022 by RACmonitor.