How to Win Medicare Appeals

How to Win Medicare Appeals

Author: David D. Mullens

Publisher:

Published: 2020

Total Pages: 280

ISBN-13: 9781641055994

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"This book is about how to successfully fight for the payment of medically reasonable and necessary services when Medicare erroneously denies payment, or when Medicare erroneously demands a repayment of overpayment"--


Hurry Up and Wait: Our Broken Medicare Appeal System

Hurry Up and Wait: Our Broken Medicare Appeal System

Author: Bob Soltis

Publisher: Lulu.com

Published: 2015-07-30

Total Pages: 100

ISBN-13: 1483434974

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In the last four years, the Chief Judge's office at the Office of Medicare Hearings and Appeals has squandered millions of our tax dollars hiring HQ staff instead of worker bees. It affects all of us, not just those enrolled in Medicare. Hurry Up and Wait relies on the perspective its author gained presiding over more than 3,500 Medicare hearings as an administrative law judge. It gives an overview of Medicare, explains the appeal process, shows how mismanagement at OCALJ and poor work by CMS contractors created a 600,000 case backlog, analyzes proposals to fix the problem, provides real solutions, and shows you how to make your voice heard to make much needed changes in the system. A portion of the proceeds are donated to worthy causes, such as the Center for Medicare Advocacy, and Save Lakewood Hospital. Note: You can buy a book without setting up a Lulu account. Thank you.


A Practical Guide to Medicare Appeals

A Practical Guide to Medicare Appeals

Author: Kathleen Scully-Hayes

Publisher: American Bar Association

Published: 2007

Total Pages: 436

ISBN-13: 9781590318270

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A Practical Guide to Medicare Appeals describes the steps necessary to successfully resolve appeals of all types of Medicare determinations. Co-authored by a CMS hearing officer and a private practitioner with years of Medicare appeals experience, this book will walk practitioners through every step of the very confusing and sometimes self-contradictory rules so that appeals can be decided on their merits rather than barred for procedural rules violations.


Guide to Medicare Coverage Decision-making and Appeals

Guide to Medicare Coverage Decision-making and Appeals

Author: Eleanor D. Kinney

Publisher:

Published: 2002

Total Pages: 250

ISBN-13:

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Effective negotiation is essential to the success of any law practice. To help you sharpen your negotiating skills for the challenges you face every day in your professional life, The Lawyer's Guide to Negotiation is a book for lawyers written by lawyers that is uniquely designed to make winning at the negotiating table the norm rather than a hit-or-miss proposition. By following the practical, no-nonsense principles and tactics outlined in this easy-to-read, common-sense guide, you ll find out how to consistently get what you want out of any negotiating session.


What Are... Medicare Appeals?

What Are... Medicare Appeals?

Author: Jessica L. Gustafson

Publisher: American Bar Association

Published: 2015

Total Pages: 61

ISBN-13: 9781627228787

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A complete overview of the Medicare FFS audit and Medicare appeals environment.


Denials Management & Appeals Reference Guide - First Edition

Denials Management & Appeals Reference Guide - First Edition

Author: AAPC

Publisher: AAPC

Published: 2020-03-17

Total Pages: 16

ISBN-13: 1626889821

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Recoup lost time and revenue with denials management and appeals know-how. Claim denials can sink a profit margin. And given the cost of appeals, roughly $118 per claim, not all denials can be reworked. A practice submitting 50 claims a day at an average reimbursement rate of $200 per claim should bring in $10,000 in daily revenue. But if 10% of those claims are denied, and the practice can only appeal one, they lose $800 per day—upwards of $200K annually. Your medical claims are the lifeblood of operations. Don’t compromise your financial health. Learn how to preempt denials with the Denials Management & Appeals Reference Guide. This vital resource will equip you to get ahead of payers by simplifying the leading causes of denials and showing you how to address insufficient documentation, failing to establish medical necessity, coding and billing errors, coverage stipulations, and untimely filing. Rely on AAPC to walk you through the appeal process. We’ll help you establish protocols to avoid an appeals backlog and teach you how to identify and prioritize denials likely to win an appeal. What’s more, you’ll learn when a claim can be “reopened” to fix a problem. Collect the revenue your practice deserves with effective denials and appeals solutions: Know how to analyze your denials Defeat documentation and compliance issues for successful claims success Utilize payer policy for coverage clues Lock in revenue with face-to-face reimbursement guidance Refine efforts to avoid E/M claim denials Ace ICD-10 coding for optimum reimbursement Put an end to modifier confusion Stave off denials with CCI edits advice Navigate the appeals process like a pro And much more!