tci Medicare Compliance & Reimbursement - 2019 Issue 7

Appeals: Remember the 5 Levels of the Medicare Appeals Process

Tip: First, try reopening a claim before you appeal. If you’re fuzzy on how to appeal a denied Medicare claim, it may be time to revisit the stages of the appeals process. Reopening and Redetermination Are Two Different Things As a Medicare provider, CMS allows you to appeal a claim decision you disagree with. “If a provider is dissatisfied and the remittance advice is an MA01, you have your appeal rights,” reminds Carleen Parker, a provider outreach and education consultant with Medicare Administrative Contractor (MAC) NGS in the “How to Avoid Missed Determinations” webinar last...

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