Part B Insider (Multispecialty) Coding Alert
MAC Sees Rise in Appeals Mistakes
PDF
CMS paperwork can be confusing, but one Medicare Administrative Contractor is reporting an uptick in problems with appeals processing. "CGS [Medicare] has noticed an influx in receiving misrouted appeal requests from providers," said the MAC in a notice last month. "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.
Related Articles
Part B Insider (Multispecialty) Coding Alert
- Enforcement:
OIG Utilizes Providers' Data in Biggest Fraud Takedown Ever
EHR vendor's shoddy software causes false claims - and a $155 million fine. Data drives [...] - Compliance:
Conquer These 10 Claims Catastrophes With Expert Advice
Tip: Don't let your font choice impact your Part B claims. Clean claims are easy [...] - Part B Payment:
CMS Eases Up on QPP Requirements in 2018
Hint: You can still use your 2014 CEHRT, feds say. As Part B clinicians ramp [...] - Part B Coding Coach:
CPT® 2018: Test Your Cardiology Coding Smarts with These Tough Questions
Remember: Don't count on 34825 and +34826 in 2018. With Jan. 1 around the bend, [...] - Physician Notes:
MAC Sees Rise in Appeals Mistakes
CMS paperwork can be confusing, but one Medicare Administrative Contractor is reporting an uptick in [...]