Hint: There are five levels of appeal. The MAC National Government Services recently held a webinar to help you demystify the five levels in the Medicare Part A and Part B appeals process. If you ever have to file an appeal, it is vital for you to understand how each level works. Bust the following myths to elevate your knowledge of the appeals process. Myth 1: Reopenings are the Same as Appeals Truth: A reopening, also referred to as a preredetermination is not an appeal, but a request to reopen a claim, according to Shelly Dailey, MSN, BSN, RN, CPHM, Medicare home health and hospice clinical consultant at National Government Services. Reopenings are not processed through the appeals department and only occur at the discretion of the contractor, Dailey explains. If a contractor refuses to reopen a claim for a minor error, that decision is not appealable. Timeline: A reopening can be performed within one year of the claim’s finalized date, Dailey says. There are several reasons for a reopening, according to Dailey. These include the following: On the other hand, appeals are different from reopenings. You cannot file an appeal for a reopening. Appeals: Before an appeal request can be made, you first have a processed claim, according to Dailey. When Medicare has either fully or partially denied the claim, then you may submit an initial appeal for a redetermination, which is also known as a Level 1 appeal. The purpose of the appeals process is to “ensure correct adjudication of claims,” Daily explains. CMS governs all appeals activities. Additionally, all providers and beneficiaries have the right to appeal any claim determination their MAC makes. Myth 2: There are 3 Levels of Appeal Truth: There are actually five levels of appeal. They are as follows: Don’t miss: Documentation is the key to the success of any level of appeal, Dailey says. Providers must include all pertinent information to avoid the dismissal of the case. Myth 3: Time Limits for Filing Appeals Don’t Matter Truth: There are actually strict time limits for filing at each level of appeal, Dailey explains. They are as follows: