tci Medicare Compliance & Reimbursement - 2023 Issue Q1

Reader Question: Know These Important Facts on Reopenings

Question: Our team is trying to  create an appeals policy and we’re looking for a little bit of guidance. Over the last year, the third-party biller we utilize submitted Medicare claims with clerical errors. Consequently, those errors led to several denials, and now we’re starting the appeals process for those claims. What is the first step we should pursue? Do we contact our Medicare carrier directly? South Carolina Subscriber Answer: No, you should avoid calling the Medicare Administrative Contractor (MAC) if possible. In fact, the reps at your MAC will simply tell you to submit your appeal...

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