tci General Surgery Coding Alert - 2024 Issue Q2

Reader Questions: Grasp These 5 Stages of Contesting Medicare Rejections

Question: I filed a claim for a Part B patient with my Medicare Administrative Contractor (MAC), but it was rejected by Medicare. I intend to challenge this decision. Can you explain the different levels of the Medicare appeals process? Vermont Subscriber Answer: The Medicare appeals process consists of five stages. Prior to initiating an appeal, you need a claim that Medicare has either completely or partially rejected. The stages of appeals include the following: Level 1: Redetermination, which goes through your Medicare Administrative Contractor (MAC). Caution: For a Redetermination Level 1 appeal to be considered complete, the provider must...

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