CMS proposes benny appeals

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Monday, September 30, 2002

WASHINGTON - At least one billing expert is hailing CMS's proposal to create a process for beneficiaries to appeal local or national Medicare coverage determinations as good news, not only for beneficiaries but providers.

"It gives the provider more ammunition," said Ward Cook, president and CEO of Allegro Medical Billing in Tampa, Fla. "When the provider calls and complains, they think, 'Well, naturally, he wants to get paid.' The beneficiary has a lot more weight."

Although beneficiaries who believe a covered item or service has been denied improperly already have the right to appeal individual claims denials, the proposal would give beneficiaries an additional avenue for challenging the underlying coverage policy. According to a statement from CMS, decisions in these appeals could have implications for future Medicare coverage for all beneficiaries, not just the beneficiary who filed the appeal.

"The new appeals process would ensure that complaints are reviewed in a predictable, uniform manner," the CMS statement said. HME

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