tci Part B Insider - 2003 Issue 27

APPEALS: Know the Difference Between a Review and a Fair Hearing

Overwhelm carriers with facts and legal background, not emotion So your local carrier has kicked some claims back to you, and you're staring at your broken dreams of reimbursement. Luckily, there are things you can do to rescue the situation and get those claims paid after all. Understand the difference between denials and audits. For a claims denial, you can request a review, then go to a fair hearing and finally to an administrative law judge, says attorney Alice Gosfield with Gosfield & Associates in Philadelphia. But with an audit, you don't get a review before you have to...

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