tci Part B Insider - 2019 Issue 5

Appeals: Know the 5 Levels of the Medicare Appeals Process

Hint: Reopen first, before you try for an appeal. If you find the Medicare appeals process confounding, it may be time to review the stages of the appeals ladder. Reopening and Redetermination Are 2 Different Things As a Medicare provider, CMS allows you to appeal a claim decision you disagree with. “If a provider is dissatisfied and the remittance advice is an MA01, you have your appeal rights,” reminds Carleen Parker, a provider outreach and education consultant with Medicare Administrative Contractor (MAC) NGS in the “How to Avoid Missed Determinations” webinar last month. There are five...

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