Anesthesia Coding Alert

The Provider Reimbursement Review Board, an independent panel established by the Medical Group Management Association (MGMA) in conjunction with the Health Care Financing Administration (HCFA) has been established to help appeal reimbursement decisions. Specific instructions for providers on how to withdraw or reinstate an appeal can be found on HCFAs Web site.

Instructions explain accelerating the process for a particular case and other reinstatement issues, and identify several requirements that providers must meet during an appeal. These include:

1. Communications. The case number assigned to your appeal must be on all correspondence with the board. The provider and the intermediary must both have copies of all correspondence about the case that is submitted to the board.

2. Letter of representation. The provider must select one person to serve as a representative with the board during the appeal process.

3. Position papers and scheduling a hearing date. The board will provide you with a schedule for filing position papers and holding the hearing. Once the board has received your final position papers, a hearing date will be scheduled.

4. List of issues. A signed list of issues (LOI) must be submitted to the board and intermediary within 30 days of the board acknowledging the appeal. Specific deadlines and provisions apply to this portion of the appeals process, so providers should be certain that the boards conditions are being met.

5. Home office issues. If home office adjustments are included in the appeal, the LOI must include information about which providers in your organization have the same issues in dispute and the total amount in controversy.

6. Accelerated hearings. If the board has received the signed LOI, the provider may request that the hearing date be rescheduled to an earlier month.

7. Withdrawing an appeal. Providers may withdraw an appeal or any issue in an appeal for any reason. A withdrawal request must be submitted to the board in order to cancel the appeal.

8. Reinstatement requests. The board will consider reinstatement requests, which fall into one of two categoriescases that were settled but for which the provider hasnt received payment, and cases that were previously dismissed by the board. Both scenarios require paperwork that specifically documents why youre requesting reinstatement and the issues that should be reinstated. Once the proper paperwork has been submitted, the board will consider the request.

Appeals help is available to any provider meeting the boards criteria. More details about the review board are available on the Medical Group Management Associations (MGMAs) Web site at www.mgma.com. The information is in the sites archives, so enter Provider Reimbursement Review Board in the search box to get the complete article. You can also log on to the HCFA [...]