tci Medicare Compliance & Reimbursement - 2015 Issue 20

Claims Reviews: How the New Guidance is Especially Positive for Therapy Appeals

Understand how review limitation will affect your over-cap therapy claims. If you’re concerned about appealing therapy claims, here’s why the recent guidance is good news for you. Limiting the scope of contractors’ reviews of appealed claims may end up turning the tables for therapy providers who are now receiving the results of manual medical review of therapy over the $3,700 threshold. Therapy providers are particularly interested in appealing unfavorable decisions, including institutional providers billing on the UB04 claim form, according to an Aug. 29 blog posting by Nancy Beckley, MS, MBA, CHC, president of Nancy Beckley...

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