Friday, December 31, 2004

Cut costs, not quality
with Esther Apter

Q. Since Medicare appeals have to be filed in 120 days, how can I make sure I don’t lose timely-filing and file effective appeals?

A. The timely-filing window of opportunity for initial submission is longer than for a denied claim. Not all rejected claims are classified as denials. The codes listed on the remittance advice specify the reason for the rejection as well as which claims must be appealed within 120 days. All other claims can be resubmitted as an initial submission. It is helpful to have a clear understanding of the reason for the denial. The remarks and rejection codes are helpful in understanding most denials. To file an effective appeal, create a review-cover-sheet that includes patient demographics, provider information, the reason for the denial and the reason you are appealing the denial. List the attachments on the review-cover-sheet and ensure they prove your case. The relevant information on the attachment should be circled or highlighted. Explain all the reasons the denial should be reversed on the review-cover-sheet. Include a copy of the EOMB. Do not include a claim form.

Esther Apter is the president of Healthcare Management Solutions: