Understanding the Medicare Appeal Process: Getting Your Claims Paid

Nothing is more frustrating than submitting a claim for payment and having the claim denied. Whether the reason is as simple as an incorrect beneficiary name, inappropriate bundling or a question of medical necessity, this initial determination of a claim from the contractor is the bane of existence for many urologists'; offices. It takes time and effort of the billing staff to determine if the determination was appropriate. In order to get these denied claims paid, there are certain appeals processes for both Medicare and commercial insurers which are different and must be followed.