ED Coding & Reimbursement Alert - 2015 Issue 38
How The New Guidance Is Especially Positive for Therapy Appeals
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Article Overview
This article explains recent Medicare appeals guidance as it relates to therapy providers, especially those dealing with over-cap claims and manual medical review. It also discusses how appeal review scope may change, when the guidance applies, and why providers should avoid processing a new claim and an appeal for the same service at the same time. The piece is useful for therapy billing staff, compliance teams, and anyone managing Medicare appeal workflows.
Why This Topic Matters
Providers handling therapy appeals need to understand changes that may affect how contractor reviews are conducted and how appeal timelines are calculated. The article also highlights a filing error that can affect whether a claim is dismissed, delayed, or denied.
What You Will Learn
- How recent guidance may affect review scope in therapy appeals
- Which therapy claim situations are discussed in relation to over-cap review
- Why filing both an appeal and a new claim for the same service can create problems
- How appeal timing is affected by the first remittance associated with a denial
Who Should Read This
- Therapy providers
- Medical billing staff
- Medicare appeals staff
- Compliance professionals
- Revenue cycle managers
Codes Discussed
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