decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Appeals / Medicare revamps its appeals process
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Article Overview
This article explains Medicare claims appeals process changes that took effect on January 1, 2006. It is aimed at billing and coding professionals who need to understand the revised administrative pathway, the role of Medicare contractors and QICs, and the CMS publications that describe the updated procedures.
Why This Topic Matters
Appeals workflow changes can affect how claims disputes are handled, the sequence of review, and the timing of decisions. Staying current with CMS guidance helps practices and billing teams follow the correct administrative process.
Article Sections
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Medicare appeals process changes
Introduces the revised Medicare claims appeal workflow and notes that the changes were intended to affect how appeals are handled and timed.
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Reconsideration and further review
Summarizes the added administrative review stage and the next level of appeal referenced for dissatisfied parties.
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CMS guidance references
Points readers to the CMS transmittal and claims processing manual sections cited as source guidance for the updated process.
What You Will Learn
- How the Medicare claims appeals process was revised
- What new review stages are mentioned in the updated process
- Which CMS publications are cited as reference materials
- Who handles the intermediate review stage in the appeals pathway
- What general factor affects access to a higher-level administrative hearing
Who Should Read This
- Medical billers
- Coding professionals
- Revenue cycle staff
- Practice managers
- Compliance staff
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