Reader Question: Questioning Reimbursement

Question: Suppose an ambulatory payment classification (APC) allows only a small reimbursement for a very expensive drug or procedure. What recourse do I have to question or appeal the amount? If I have to go to my Medicare carrier, how should I address the problem?

Arkansas Subscriber

Answer: You might consider establishing a dialogue between you and your local carrier or the regional office if only to establish reasonable doubt about the payment amount. These amounts, however, were determined from a broad analysis of past charges, and you may not be able to change the rate, except through the methodology established by the Health Care Financing Administration (HCFA).

- Published on 2000-07-01