E/M Coding Alert - 2018 Issue 1
Billing: Find Resolution Options Beyond 'Appeal'
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Article Overview
This article explains several Medicare and claim-processing options that may help providers address rejected, denied, or appealed claims without defaulting to a standard appeal. It is aimed at billing staff, coders, and revenue cycle professionals who handle claim corrections, documentation checks, and Medicare appeals workflows. The piece discusses general claim correction concepts, unprocessable claims, external review options, claim preparation checks, and a Medicare settlement initiative for certain low-volume appellants.
Why This Topic Matters
Understanding the available resolution paths can help practices reduce avoidable appeals, correct administrative claim errors more efficiently, and identify when a claim may qualify for an alternate settlement process.
Article Sections
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Tip 1: Reopen, When You Can
Introduces a claim-correction option for certain finalized claims and outlines the kinds of administrative items discussed in the article.
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Tip 2: Don't Appeal Unprocessable Claims
Explains the article’s discussion of claims returned with missing or invalid required information and why these claims are treated differently from processed denials.
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Tip 3: Remember the IRO Option
Covers the external review path mentioned for claims that have already gone through the appeals process and the broader context of that option.
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Tip 4: Avoid Errors From the Start
Reviews the article’s emphasis on claim-preparation checks and general submission items that should be verified before filing.
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Tip 5: Earn Easier Settlement Option with Few Appeals
Summarizes the Medicare settlement initiative discussed for certain appellants with low volumes of pending appeals and related program context.
What You Will Learn
- How the article distinguishes between claim reopening, appeal, and resubmission concepts
- What types of claim issues are discussed as preventable through front-end verification
- What general Medicare appeals and settlement topics are covered
- Which broad claim data elements the article says should be checked before submission
- What low-volume settlement initiative is described in the article
Who Should Read This
- Medical billers
- Coding professionals
- Revenue cycle staff
- Practice managers
- General surgery practice administrators
- Medicare claims staff
Modifiers Discussed
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