Be Well-versed With Medicare Appeals Process

By Author: Julia Rose
Total Articles: 89
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Some time back, Centers for Medicare and Medicaid Services (CMS) announced several changes to the appeals process in Transmittal 1762. As such, you need to update your appeals know-how. Here's what you need to do:


Focus on higher dollar amounts


CMS has changed the dollar amount in controversy to file certain levels of appeals. For level-three appeals (administrative law judge hearing) requests filed on or after January 1, 2009 must have at least $120 in controversy. Earlier the amount was $100. For level-five appeals (federal court review), requests filed on or after January 1, 2009 must have at least $1,220 in controversy. Earlier it was $1,180.


Get to know the five-steps in Medicare appeals process


Be well-versed with these five steps: Re-determination, re-construction, Administrative Law Judge, Medicare Appeals Council, Federal Court.


Increase your potential for successful appeals


It is highly important that healthcare providers and billers know the thresholds set by Medicare. If you ...
... know the rules, your chances for a successful appeal are much more. And now that Medicare can no longer correct minor errors or omissions on claims through the appeals process, you have to be geared up and submit clean appeals.


For more billing and coding know how, you can go for medical billing and coding conferences and stay up to date. These medical conferences will certainly help you get up-to-the minute industry updates, one-on-one access to a coding expert, and much more.


So what are you waiting for? Go for one, and pep up your billing and collections know how and be on mark as far as the reimbursements are concerned.


Gain knowledge about medical conferences by attending proper Billing and collections conferences along with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.