Author Topic: Medicare | Appealing Claims  (Read 1004 times)

avehildebrand

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Medicare | Appealing Claims
« on: June 27, 2018, 03:10:47 PM »
Hello,

I work at a Physical Therapy office and one of our PT's validation never got renewed for Medicare and she was the "rendering provider". So all of our claims have been denied due to her no longer being eligible. I went ahead and re submitted the 855i for her to add her back onto our group. Once she is approved I then need to file appeals for all of the outstanding claims that were originally denied.

Does anyone have any experience filing appeals with Medicare? Or any advice that would be helpful once I start that process? I am concerned that they will not pay out for any of these visits.

Thank you! :)
« Last Edit: June 27, 2018, 03:45:10 PM by avehildebrand »

kristin

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Re: Medicare | Appealing Claims
« Reply #1 on: June 27, 2018, 10:36:10 PM »
Each MAC has their own forms for doing appeals. Get on the website for your MAC, and research exactly what forms you will need to fill out/what their process is. Be aware that Medicare may only retro the revalidation back to a certain date, so anything before that date will not be paid.

Sriram_Sub

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Re: Medicare | Appealing Claims
« Reply #2 on: June 29, 2018, 09:54:44 AM »
I know of a friend of mine who worked for a provider whose enrollment was suspended for just a couple of days because they received the revalidation application only 2 days post his validation expiry. The billing team tried requesting for reconsidering the claims for those 2 days. But had no luck. I believe it was for a WA based provider. But, it is worth making an attempt. Please try appealing after you have a word with a provider enrollment representative.
Sriram

Medical Billing Forum

Re: Medicare | Appealing Claims
« Reply #2 on: June 29, 2018, 09:54:44 AM »