Publisher's Synopsis
<p> Anyone who submits Medicare claims and receives Medicare reimbursements needs to be fully prepared to follow the appeals process when claims are rejected and/or refunds are requested. </p> <p> <b>Medicare Claims Appeals Process Handbook</b> helps you understand - and explain - the process every step of the way. You'll know exactly what you can and can't do, the essential timeframes for pursuing appeals, where to send information, and how to proceed - at every level of the appeals process! </p> <p> The <b>Medicare Claims Appeals Process Handbook </b>will help you:Increase your likelihood of success in the claims appeal by lowering the possibility of procedural error and avoiding costly errors </p> <ul> <li> Navigate all four levels of the administrative appeal process </li> <li> Proceed to federal court if necessary </li> <li> Stay current with changing rules, regulations, and procedures </li> <li> Put best practices in place - immediately! </li> </ul> <p> Only <b>Medicare Claims Appeals Process Handbook</b> includes letters, forms, charts, and more - all designed to provide you with practical support throughout the process. </p> <p> <b>Medicare Claims Appeals Process Handbook</b> has been updated to include: </p> <ul> <li> Expanded material on electronic claims submission </li> <li> A sample denial of an “unusual circumstance” waiver request </li> <li> Information on medical necessity denials </li> <li> A new National Coverage Analysis (NCA) tracking sheet and proposed decision memo for MRIs </li> <li> Updated Medicare redetermination request forms </li> <li> Request for review of Administration Law Judge (ALJ) Medicare decision/dismissal </li> <li> Comparison of standard and expedited appeals processes </li> <li> Updated CMS appointment of representative form </li> <li> New material on the role of the Medicare administrative contractor </li> <li> A sample Medicare Summary Notice </li> <li> Important information on overpayment and suspension of payments </li> <li> Recent case law regarding exhaustion of administrative remedies </li> <li> Updated material on good cause for reopening </li> </ul> <p> </p>
