tci Medicare Compliance & Reimbursement - 2017 Issue 20

Clip And Save: Consider This Claims Advice Before Your Next Appeal

Excessive appeals often alert payers to fraud. Denials are inevitable in the business of medical billing. Ultimately, how a billing practice handles a denial is up to the discretion of the provider and the officer manager. However, sending appeals to a payer when the documentation does not support the coding not only will cause the appeal to be denied (again), but could alert the payer that the practice has been billing erroneous claims. Enough of these red flags could increase the likelihood of an audit. When an appeal includes documentation that does notsupport the coding, the practice is telling...

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