What to Do? Have you ever opened a Payer Newsletter and seen something you completely disagree with regarding reimbursement or coverage? What is your first reaction? Do you jump on social media, send the link to colleagues, and threaten to go ‘all cash?’ Is there anything else you can do? At KMC University we have…
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Protect Your Reimbursement The Accounts Receivable process often requires you to follow up on denied claims or recoupment requests. If you are using the KMC University follow up system, these are located in the Reactive Follow Up file. During the investigation process you may come across one of the following issues: Claim denied because service…
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Making sure you get the money you have earned and that you deserve is what this mini-class is all about. Kathy walks you through the 5 levels of the Medicare appeals process. She discusses time limits for filing each level and the monetary thresholds that apply to some of them. There is additional information found…
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The Medicare Appeals Process The Medicare Part B administrative appeals process is available to beneficiaries, providers/physicians, and suppliers dissatisfied with the initial determinations, subsequent determinations, and appeal decisions. An initial determination is the first adjudication (judgment) made following a request for Medicare payment for Part B claims under Title XVIII of the Social Security Act….
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Appeal Letters & Forms If you receive a denial from an insurance carrier, other than Medicare, and you disagree with an initial claim determination, you may request a provider inquiry. A provider inquiry is the first level of appeal and must, in general, be submitted within 18 months of the date of the provider’s remittance…
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Step-By-Step Appeals Process Whether you are filing a formal appeal or a quick and easy request for reprocessing, KMC University recommends you take the following steps: Determine the Reason for the Denial It is important to identify the reason for the denial. Normally a brief description is provided on the EOB and the denial reason…
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