BC Advantage - 2015 Issue 11
APPEALS expanded under the Affordable Care Act
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Article Overview
This piece covers broad guidance on appealing denied claims in the context of the Affordable Care Act. It is aimed at billing, coding, and practice staff who handle payer communications and need a general overview of appeal preparation, documentation, and follow-up practices. The article also includes a brief organizational note about MAB and its role in medical billing and coding education.
Why This Topic Matters
Understanding the appeal process can help practices respond more effectively to denied claims, organize supporting records, and communicate with payers in a timely way.
Article Sections
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Appeal preparation tips
General steps for reviewing denial information, checking claim data, gathering supporting records, and preparing an appeal submission.
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Documentation and follow-up
Guidance on tracking payer communications, keeping records of calls, and monitoring appeal status after submission.
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Customer service approach
General advice on communicating professionally with payer representatives during the appeal process.
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MAB
A short organization note describing MAB and its educational and professional mission in medical billing and coding.
What You Will Learn
- How to review denial information before beginning an appeal
- What types of records are useful when preparing an appeal
- Why documenting payer communications can be helpful
- How to organize follow-up after an appeal is submitted
- What general organizational mission is described in the article
Who Should Read This
- Medical billers
- Coding staff
- Practice managers
- Front-office staff
- Revenue cycle staff
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