tci Medicare Compliance & Reimbursement - 2021 Issue Q4

Industry Notes: Send Your Medicare Appeals to the Right Place

If your appeals seem to be stuck in traffic, you may be sending them in the wrong direction, suggests one Medicare Administrative Contractor (MAC). In a recent alert, Part B MAC WPS-GHA suggests that some providers are causing their own appeals’ delays or dismissals by confusing their level of appeals and sending documentation to the wrong location. “Before sending your appeals request, verify which contractor completes the level of appeal,” WPS-GHA advises. “Is it the Medicare Administrative Contractor (MAC) or Qualified Independent Contractor (QIC)?” Providers should send their redeterminations (level one of Medicare appeals) to...

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