Practice Management Alert

In 2006, you will have to follow new rules on time frames for requesting first- and second-level appeals.

One of the most important changes for billers to note is filing requests for the first level of appeal, also known as a redetermination. Medical offices are supposed to file a request for redetermination within 120 days, but carriers will still accept your appeal request after the deadline, in certain situations. 

Carriers Can Accept Late Appeal Requests

If you file a request for redetermination after the 120-day deadline, your carrier can still accept the request. Carriers have until the first of the year to come up with a procedure for deciding whether you had a good reason to submit the request late, according to CMS.
 
Call Carriers Next Year

Billers should check with their carriers after Jan. 1 to ask  about their request for redetermination exceptions policy. Also, remember that a request for redetermination is considered received on the date that the carrier's corporate mailroom receives the document, according to Medlearn Matters article 3942.

Reconsideration Window Not Open a Full 6 Months

Billers should also be aware of the change to the time frame for submitting a second-level appeal, which is also known as a reconsideration. Physicians will have 180 days to file for a reconsideration, but some offices may miss the deadline because they have 180 days, not six months, to file the request, according to Tammy Tipton, president of Appeal Solutions in Blanchard, Okla.
 
Remember: The 180-day window to request a reconsideration includes weekend days.