E/M Coding Alert - 2013 Issue 11
Reimbursement: Appeal Medicare Advantage 2 Percent Slashes
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Article Overview
This article discusses Medicare Advantage reimbursement policy in the context of sequestration and a CMS memorandum to Medicare Advantage organizations. It is aimed at practices, billing staff, and reimbursement professionals who need to understand how contract status affects payment adjustments and when payer actions may conflict with approved plan terms. The piece provides a high-level overview of the issue, the CMS guidance, and the general appeal implications for affected claims.
Why This Topic Matters
It helps providers and billing teams recognize when Medicare Advantage payment reductions may not align with contract language and when claim reductions may warrant review or appeal.
What You Will Learn
- How Medicare Advantage reimbursement is affected by sequestration-related payment changes.
- Why contract status matters when reviewing Medicare Advantage claim reductions.
- What type of CMS guidance is relevant to payer payment adjustments.
- When a practice may need to review and appeal reduced payments.
Who Should Read This
- Medical billers
- Coding professionals
- Practice managers
- Revenue cycle staff
- Physician practices
- Medicare Advantage providers
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