Medicare Compliance & Reimbursement - 2008 Issue 17
PART B MYTHBUSTER: Proceed With Caution When Device Maker Offers to Appeal for You
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Article Overview
This article discusses a Medicare Part B appeals scenario in which a device manufacturer offers to handle an appeal after a claim denial. It explains why coding and appeals professionals may prefer to manage the process themselves, what kinds of manufacturer-provided information may be useful, and what practical questions to ask before relying on outside help. The piece is aimed at coders, auditors, and appeals staff who work with device-related claims and payer disputes.
Why This Topic Matters
Appeals involving devices can affect payment, provider relationships, and coding compliance. Understanding how to evaluate manufacturer involvement helps teams protect claim integrity while pursuing reimbursement.
Article Sections
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Myth vs. reality
Introduces the central claim about who should manage a denied claim appeal and contrasts it with a more cautious approach.
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Example and professional perspectives
Presents a device-related denial scenario and summarizes comments from coding and appeals professionals about using manufacturer information carefully.
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Questions to ask before letting a manufacturer lead
Outlines the kinds of follow-up questions a provider office may want to ask when considering outside appeal assistance.
What You Will Learn
- How the article frames manufacturer involvement in the appeals process
- What types of manufacturer information may be helpful without replacing internal oversight
- Which practical considerations to review before allowing a third party to manage an appeal
- How appeals staff may evaluate the reliability and follow-through of outside assistance
Who Should Read This
- Medical coders
- Coding auditors
- Appeals specialists
- Revenue cycle staff
- Orthopedic and neurosurgery practice staff
- Medicare claims staff
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