Revenue Cycle

Get your appeals process ready

Recovery Auditor Report, August 19, 2008

To prepare for the nationwide rollout, it’s important to get your appeals process in place, says Linda Fotheringill, Esq., an attorney who specializes in overturning RAC appeals and Medicare denials.

“You need to fight back or you’re going to have a target on your head,” says Fotheringill, a founding member of Washington & West, LLC, in Baltimore, MD, and the law firm of Fotheringill & Wade, LLC. “If not, it increases the likelihood [RACs] are going to continue going there.”

Fotheringill offers the following tips on establishing your appeals process:

1. Make sure that you have a process in place to recognize a notice of denial and that a team is in place to take action in a timely fashion.

2. When sending in a medical record to appeal, send the entire record. Do not take abstracts and bits and pieces.

3. Make sure the reviewer has received training in how to analyze a case with relevant Medicare regulations.

Editor’s note: The preceding is an excerpt from the upcoming September edition of HCPro, Inc.’s newsletter, Patient Access Advisor. To learn more about Patient Access Advisor, click here.

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