Long-Term Care

Master the Medicare appeals process

Billing Alert for Long-Term Care, August 1, 2009

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

At one point or another, many SNFs will disagree with their fiscal intermediary’s (FI), Medicare administrative contractor’s (MAC), or carrier’s decision to deny a claim. When this occurs, a facility should not hesitate to file an appeal.

“Appealing a denial must be a team effort, involving all facility staff members who participated in billing or providing the service in question,” says Frosini Rubertino, RN, CRNAC, C-NE, CDONA/LTC, clinical services consultant at LTC Systems, headquartered in Conway, AR.

Although the individual staff members involved may vary depending on the service or reason for denial, a facility’s MDS coordinator, administrator, billers, therapists, and members of the clinical and medical records staff all typically play a role in the appeals process.

Nursing home billers are critical to preventing and identifying denials and gathering information for an appeal. Since the appeals process can be confusing and time-consuming, SNF billers must have a clear understanding of the system and the important role they play.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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