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4 Important Points – Medicare Appeal

We typically have 120 days from the denial date to request an appeal. Medicare maintains very strict filing deadlines for each level of appeal. To avoid issues, don’t hesitate to request an appeal to your denied claims. There’s no reason to sit on your denials—prioritize appeals and ensure you get them in well before the deadline.

If your practice has a policy to appeal every denied claim, it’s time to rethink that protocol. Appeals are time-consuming and costly, and in some cases, Medicare was correct to deny claims. No practice has a 100 percent success rate in accurate claim submissions, and it’s possible that your services simply did not meet Medicare’s payment criteria.

You should pursue the appeals process when it’s cost-effective to do so and you believe your odds of success are high, but it’s important to evaluate every claim before appealing.

It is good to have a second level audit done before sending any medical records. By this way we know that we are sending accurate and detailed medical records to Medicare and avoid further denial requesting additional records. This will help to save time and facilitate to process the appeals on time.

One must document the name of every representative you talk to, and keep a log of everything they told you. In your appeal record, write down why your claim was denied, how you followed up on the denial, the names of everyone you talked to, what they said, and which dates you moved through every step of the appeal.

If you end up having to take your appeal to the next level, you’ll be armed with detailed information about what you’ve already accomplished, helping speed the process. In addition, if another party needs to get involved—like an attorney—you’ll be able to give them a thorough record of what you’ve done.

Fixing the issue across the board can help prevent future denials and the accompanying appeals, so be sure to fix any problems you see in your coding, billing or claims processes, and train your staff on how to file clean claims, with examples from past denials. This will help you reduce your denials and save time since you won’t have to appeal as many claims going forward.

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