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CodeMap Compliance Briefing: 5/16/03: Revised Medicare Appeals Provisions

Editor's Welcome: As consultants, we are often asked what to do about Medicare carriers who consistently deny payment for seemingly clean claims. Often the only solution is to use the Medicare appeals process. If everyone assumes someone else will take up the battle, payers remain unaware of the problem and turn questionable actions into established policy that is difficult to change.

Only providers and beneficiaries may appeal Medicare claims. An effective compliance plan should include regular review of all denied claims and the filing of appeals in appropriate cases. Consistent use of the appeals process results in improved collections and faster resolution of billing questions and provides valuable documentation showing that you are serious about Medicare compliance.

The next two compliance briefings will explain the Medicare Part B appeals process and the recently implemented changes. This week we will discuss the first step of the process, the Carrier Review, and next week we will examine the subsequent two steps, the....

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