Call Medicare Denials - 5 things you need to know

Call Medicare Denials - 5 things you need to know -

Call refusal Medicare is likely to be a reality for all outpatient therapy providers this year. Therapy on the $ 3,700 cap is subject to 100% mandatory medical examination by auditors Recovery (ICAR) through 31/03/2013. In his comments, if favorable, will frustrate you at first, then anger can you then require you to file an appeal. Phone calls and emails today, customers and non-customers show growing frustration with the medical review process manual, some misunderstandings about the examination of 10 days in the prepayment review states, and entering suppliers in the appeals process have a rude awakening two-year backlog of appeals. I covered in this blog on the ALJ appeal Forum. It should not take more time and get right to the 5 things you need to know when to call Medicare denials

Call Medicare Denials -. Here are "5"

1. Medicare official appeals process, and your Mac will have PDF forms and interactive instructions to get you started. Also check the CMS website called complete rules and references.
2. RECOVERY (for post-payment review) will begin on 41st day from the date of the letter of demand if your Mac does not receive one of the following by the 30th day from the date of the letter of request full payment, a request for an extended repayment schedule. or a valid request for reconsideration
3. If you use ESMD (congratulations!) to submit to FCAC, you will return to the post for the appeal process. ESMD is expanding to calls in 2014, but we are not there yet.
4. Organize all documents and include a cover letter (last chance!) With an executive summary cases (think like an excellent D / C ratio), a refutation of the refusal and the documents index . Try to put items as evidence in early as possible in the appeal process
5. Despite 24 -. 30 months behind the ALJ hearings now, appeal your case if you have found tenable. CMS collects data about calls, and when you win (positive thinking), you interest on your payment.

Are you in calls due to refusal of RAC? Do you know that you will probably be in the calls because of adverse effects on hold? What questions do you have?

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Nancy Beckley

Nancy J. Beckley is the president of Nancy Beckley & Associates LLC, a firm specializing in compliance with outpatient therapy. The firm offers outsourcing the compliance risk assessment, compliance plan development, annual compliance training, and external audit, due diligence and investigative support. Customers are suppliers under Medicare review of the probe, the plans of progressive corrective actions, corporate integrity agreements, ZPIC investigations and RAC audits.

Nancy background includes 15 hospital years experience in the service management capabilities to two large rehabilitation facilities for inpatients with extensive managed care contracting and program management expertise. A therapist in the background and training, Nancy served as program director, director of the institution and administrator in both rehabilitation facilities for inpatients and outpatients.

She is a nationally recognized speaker in the field of rehabilitation of compliance, and presented to the Conference Provider Practice Compliance, Florida Compliance Conference, and the Healthcare Compliance Compliance Institute Association. It was described in a Healthcare Compliance Association webinar on the risk of hospitalization in outpatient therapy, and wrote three articles for compliance Today and written over 20 articles on the RAC program.

Mrs. Beckley area of ​​expertise includes:.

• Development of the compliance program, consulting, training, and the external auditor

• Medicare Regulatory requirements for suppliers outpatient therapy, including extensive experience in the investigation and Medicare certification for outpatient treatment providers

• auditing and consulting commitments under attorney-client privilege for risk assessment and the analyzes the potential recovery of responsibility

• Medicare program integrity initiatives: MACs, RACs, CERTs, ZPIC, critics of the probe before and after payment of examinations

• recognized expert national level on CORFs, served on the technical expert Group Medicare CORF

• outpatient Hospital board compliance, audit and training

• compliance diligence activities due in the acquisition and portfolio development to assess compliance risk Medicare

EDUCATION: University of South Florida, MBA; Harvard School of Public Health course for managed care executives; University of Illinois, m.s. University of Wisconsin, B. s

PROFESSIONAL ASSOCIATIONS: Board of Directors, National Association of Rehabilitation Agencies (NARA) Members, Healthcare Compliance Association; Contributing Editor principal RAC Monitor + monitor Monday; Compliance columnist for IMPACT Journal of APTA

PROFESSIONALCERTIFICATIONS: CHC, certified Health compliance by the Healthcare Compliance Certification Board

PUBLICATIONS AND PRESENTATIONS: Available on request

CONTACT: 414-748 -4376; Nancy@NancyBeckley.com;

Latest posts of Nancy Beckley (see all )

• Call Medicare Denials - 5 things you need to know - June 18, 2014
• therapy PQRS Panic - June 5, 2014
• Medicare Confusion G code - May 28, 2014
• Medicaid exclusion controls - May 7, 2014
• Checking Importance Exclusions - April 30, 2014