tci Part B Insider - 2003 Issue 10

Appeals: Avoid Appeals Doldrums With Documentation

Cash-strapped carriers may begin pushing your appeals to the bottom of their in-boxes unless you know how to play the game. The Centers for Medicare & Medicaid Services instructed carriers to warn providers that "failure to submit appropriate documentation, if any, that supports the contention that the initial determination was incorrect under Medicare coverage and payment policies may delay appeals development and determinations." In other words, documentation is your ticket out of appeals purgatory. But that's not all. CMS provides an exhaustive list of how to prioritize appeals in Program Memorandum AB-03-052. The agency has come up with...

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