I submitted a claim to Medicare and it came back that the patient was enrolled in hospice (PR-B9). When remit came I verified through CSNAP and patient was enrolled in hospice. I was reviewing the account for collections and discovered that the patient was not in hospice for this date of service (I checked CSNAP again). I submitted a redetermination and was denied because it was past 120 days. In their explanation of why my appeal was denied, they state "In this case, we did not find good cause for filing your request late." Do I have grounds to take this to the next level of appeal?
I agree that this was after 120 days, but if they made changes to their eligibility system, then they should have reprocessed my claim and I should not have needed to appeal. This also seems crappy if I can't go to the next step because what would keep them from doing this all the time to get out of paying claims.