Unless you engage a consultant or attorney to assist, it costs nothing to submit Medicare appeals, but it can net you big money because you’ve already performed the service — and you deserve to get paid for it.
Many practices avoid appealing denials because it’s time consuming, but if you know the ropes about Medicare appeals, it you can file appeals efficiently and swiftly. Check out these tips to reverse denials and bring in more cash.
1. Consider the LCD Your Bible
Your first step in managing payer appeals is to know and understand your payer policies. Medicare local coverage decisions (LCDs) are the payers’ bible, so they should be yours as well. When payers get a claim (or an appeal), the first thing they do is review the LCD and create an internal review checklist to confirm you’ve met all the service guidelines, so you should be doing the same thing.
Pay attention to phrases like “may,” “should,” and “must” — because that will show you which details are gray areas and which are black and white.
2. Write a Cover Letter
The cover letter will succinctly tell the payer why you’re filing an appeal and why you believe your claim was incorrectly denied. It will also point out what clinical documentation you’ve included to support your appeal.
When you submit documentation, avoid using a highlighter on it, because the digital scanners that categorize your documentation may see it as a black line instead of yellow or green — and could therefore cancel out things you mean to call attention to. Instead, use the cover letter to call out those areas that you would normally highlight.
3. Use Attachments
Submit as many attachments as you believe will help reverse your denial. In addition, if you made an error on your initial claim, you should correct, initial and date those errors and submit that as an additional attachment.
4. Maximize Organization
Reviewers have a lot of appeals to review, and not a lot of time to do it. Therefore, you’ll help your case if you make it as easy as possible for them to get through your claim swiftly. For instance, if your cover letter refers to documentation or notes you’re submitting, use page numbers to direct them where to look for those items.
The more organized your appeal packet is, the more likely you are to receive a favorable determination.
5. Keep Duplicate Copies
Make sure you keep a duplicate copy of your appeal, your cover letter, and all documentation you submit so you can refer back to it. You’ll want to track your outcomes in the file for future reference, because the best way to learn from your appeals to see how they fared is to have copies of everything.
6. Confirm Receipt
Make sure you have receipt confirmation to confirm that the insurer received your appeal. This is true whether you sent it via hardcopy by mail, by fax, or if you’re submitting it electronically.
7. Submit ABN When Applicable
If you have a valid advance beneficiary notice (ABN) on file for the service, submit that with your appeal so the payer knows to apply the limitation of liability provisions to the claim.
Find even more ways to get payers to reimburse you for your services with help from expert Kelly Grahovac, MBA. During her online training, Persuade Payers to Pay Up With Successful Appeals Process, Kelly will walk you through the steps that insurers don’t want you to grasp. Register today!
Check out our Appeals Playlist on YouTube for the latest expert advice, and subscribe to our YouTube channel for step-by-step guidance!
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