Reading Time: 1 minuteFebruary 6, 2018—When Medicare claims are denied, especially for the medical necessity denials, if the doctor does not agree with the denial, the claim must be appealed. However, for the past few years, Medicare has become woefully behind on processing appeals. So much so, in fact, that they have decided to cry uncle.
On February 5, 2018, CMS began accepting Expressions of Interest (EOIs) for a limited settlement agreement option for Medicare Fee-For-Service providers, physicians, and suppliers (appellants) with fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals (OMHA) and the Medicare Appeals Council (Council) at the Departmental Appeals Board. CMS will settle the portion of their pending appeals that have total billed amounts of $9,000 or less per claim in exchange for timely partial payments of 62 percent of the net Medicare approved amount.
“When providers receive a Medicare denial code for lack of medical necessity, usually CO-50, it’s imperative to appeal,” says Kathy Mills Chang, founder and CEO of KMC University. “In fact, statistics show that more than 60 percent of appealed claims have the appeal overturned and are paid. For this reason, failing to appeal these denials simply doesn’t make sense.”
There are specific requirements and processes to throw your proverbial hat into the ring of consideration. Deadlines are dependent on the provider’s NPI number. However, the final deadline is in early April, so don’t delay.
For complete details and to find out if you are eligible to participate, visit KMC University here. https://www.kmcuniversity.com/classroom/medicare-low-volume-appeal-settlement
Source: KMC University