Financing Medicare Appeals: A Primer

The decision to appeal a denied Medicare claim or an adjustment following a MAC, RAC or SMRC audit is affected by many factors, including the potential cost of attorney or consultant assistance. Physicians and facilities may feel stymied by the need to spend money to defend their billing or coding practices. However, appeals may be necessary not only to secure payment but also to address possible fraud or false billing allegations. Also, unless action is taken quickly CMS can collect a disputed overpayment while appeals are pending.

There are ways to finance the cost of appeals beyond conventional lending and hold on to payments during appeals. Certain methods have short time frames. If requirements are met, a form of financing is provided by the applicable MAC.

Webinar Agenda

• What are the timeframes for each administrative appeal level for Medicare claims?
• How long can recoupment be delayed and what deadlines apply?
• What is the ERS program and when can it be requested?
• What’s the procedure for requesting an ERS and what documents are required?
• Can Medicare overpayment collections be stopped during an ALJ appeal?
• What are typical terms for US Treasury repayments?
• How does self-disclosure delay recoupments?

Webinar Highlights

This webinar will highlight the timeframes for appeal and for stopping collection of overpayments. It will also discuss the extended repayment schedule process in detail as well as US Treasury payment plans. Lastly, the program will address how self-disclosure programs can likewise delay overpayment recoupment.

Who Should Attend

This webinar will be of most interest to medical groups, physicians, hospitals, long term care facilities and other health care industry businesses.