When a Medicare provider has a claim denied or reopened, they face the difficult task of interpreting the complex matrix of laws, rules, and policies when attempting to file claims with the Centers for Medicare and Medicaid (CMS) for services provided to Medicare recipients.
CMS further complicates this process by providing “guidance” through a variety of resources, including position papers, clarification letters, provider seminars, and internet postings. It is not uncommon for CMS rules to be in conflict with one another, further frustrating the efforts of providers to adjudicate claims.
The substance of an appeal can be range from simply providing additional documentation to challenges to CMS policy to complex procedural arguments. The key to a successful appeal is preparation, knowledge, and experience.
Our attorneys are uniquely skilled in both the appeal process and the laws and rules governing Medicare coding and billing. We have successfully recovered hundreds of thousands of dollars on behalf of our clients. If you have questions about the Medicare Audit Appeals process or need help filing an appeal, contact Frier Levitt today.