Managing Medicare Appeals

Fleming-AOD Consulting can assist providers with all levels of the payment denial appeal process. Although the process is presented as a linear series of events, we can tailor the engagement to match the specific requirements of your hospital.

Objectives

• Assist with drafting appeal letters

• Analyze documentation to recommend medical necessity improvements

• Prepare defense for each level of appeal

Process (any or all of the following can be included in your engagement)

Site Visit Perform a program review of operations, admissions process, and IRF-PAI completion Audit charts to reveal documentation and opportunities for coding improvement Recommend documentation strategies for resistance to audits Deliverable: Written report on chart audit findings, opportunities, and recommended actions Redetermination appeals packet Prepare appeal letters for denied claims Create a sample letter for the beneficiary to send to CMS in support of the facility and encourage them to write their congressional representatives Create a sample letter to send to the referring physician to get them to write CMS in support of the patient's admission to your facility Analyze your MFI/RAC's overturn rate at redetermination Deliverable: Appeal letter and template for use with future denials

Reconsideration appeals preparation Prepare appeal template and letter Conduct an analysis of the QIC's overturn rate at reconsideration Deliverable: Appeal letter and template for use with future appeals ALJ Preparation Format documentation to present to the ALJ Review prepared documents with staff and physician Conduct an analysis of the ALJ's overturn rate Provide appeals training and staff education Deliverables: Draft letters Implementation-ready appeals process Coaching and training

What other programs does Fleming-AOD Consulting offer? »

Contact us to learn how our expertise can benefit your organization