Thursday, February 10, 2011

Problems in appealing the denied claims

Problems with Current Appeals Process

The problems with the current appeals process are twofold from the physician’s perspective, Reider says:

*You must go through two levels of appeal before you get to an “independent” reviewer who’s more likely to be sympathetic to your case; and

*  The process is too slow.

The government, specifically the OIG, doesn’t like the current appeals process either, but it has a different concern. It feels that the appeals process is unworkable because the ALJs overturn the carriers’ denials too often. The OIG’s position is that this tendency weakens its ability to fight fraud and abuse in the Medicare program.

New Process May Be Good and Bad for Physicians

Congress attempted to remedy all these concerns with the new appeals process it included in the Medicare Reform Act. Although we won’t know how it will truly play out until the new process is up and running, it’s likely to be a mixed bag for physicians, Reider remarks.

The good news. Several aspects of the new appeals process are likely to benefit physicians:

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