Anesthesia Coding Alert

Hint: Second levels don't go to MACs.

There's no doubt that CMS paperwork can be confusing, but one Medicare Administrative Contractor (MAC) is trying to help, thanks to increasing problems with processing appeals.

"CGS [Medicare] has noticed an influx in receiving misrouted appeal requests from providers," the MAC shared in a Nov. 21, 2017, notice. "In some cases, providers are using the correct contractor appeal form; however, mailing to the incorrect contractor address." The MAC, which processes Jurisdiction 15 claims, encourages providers to review thoroughly their Medicare Remittance Advice (RA) before sending appeals out. Both the name of the contractor and the correct address on where to forward appeals can be found on the RA, CGS noted in its advice.

Reminder:  Reconsiderations, the second level of the appeals process, are not processed by MACs. Those need to be sent directly to the Qualified Independent Contractor (QIC) named on your appeals letter.

Resource: For more information about CGS Medicare redeterminations issues, visit cgsmedicare.com/partb/pubs/news/2017/11/cope5230.html.