Master the Medicare appeals process
Briefings on Outpatient Rehab: Reimbursement and Regulations, September 1, 2009
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At one point or another, many rehab facilities will disagree with a decision from their fiscal intermediary (FI), Medicare administrative contractor (MAC), or carrier 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 Conway, AR–based LTC Systems.
Rehab billers are critical to preventing and identifying denials and gathering information for an appeal. Since the appeals process can be confusing and time-consuming, billers must have a clear understanding of the system and the important role they play.
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