tci Medicare Compliance & Reimbursement - 2005 Issue 19

APPEALS: Prepare Now For Quicker 2006 Appeals Turnaround

Providers that don't learn new rules early could be sorry all next year.Starting this January, having your ducks in a row will be more important than ever for providers when it comes to submitting appeals for denied claims.When the Centers for Medicare and Medicaid Services' new appeals process kicks in, providers only have one chance to get appeals right. If a provider doesn't include all the important information in its second-level appeal to the Qualified Independent Contractor, then the provider won't be able to add any more information except if there is "good cause." Also, the...

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