Resources to Decrease Denied Medical Claims.
Home | Contact Us | Member Benefits | Search | Advertising | Member Area
 JOIN NOW
Become a member & get immediate access to all of our resources.
 SEARCH


Take a Free Tour
About ALO
 Who Should Join
 Download Samples
 Member Benefits
 Terms & Privacy Policy
 Take a Tour
 Member Comments
 Frequently Asked Qs
 Advertising
Discussion Forum
 MEMBER RESOURCES
 Appeal Letters
 Audio Conferences
 Discussion Forum
 Download Library
 Articles & Case Studies
 State Resources
 My Membership
 Virtual Exhibit Hall
 Help
 APPEAL TOPICS
 Providers' Rights
 Benefit Disclosure
 Utilization Management
 Medical Necessity
 Incorrect Payments
 Prompt Pay
 Treatment Excl/Limits
 Refund & Recoupments
 Specialty Care
 ERISA
 Medicare
 Contract Negotiation
 Other Topics
Visit our Online Store.
 Forum Topics
• EXPERIMENTAL INVESTIGATIONAL
• Humana denying nail debridements when other services rendere
• UBH MNRP - SUBSTANCE ABUSE REV CODES
• UBH substance abuse denial due to rendering provider issue
• Ambulatory Surgery Center Start Date
• Denial based on facility Accrediation in CA
• AUTOMATIC RECOUPMENT-HEALTHPLUS AMERIGROUP
• LA CARE DENIALS
• Medicare denial - referring MD not eligible to refer for ser
• Federal BC pay provider
• Pay the member
• GEHA - DENIED NOT MEDICALY NEC.
• aetna denying anesthesia
• Align Networks
• Nursing Home Appeal Due to Unsafe Discharge
Home | Medicare



Appeal Topics
Medicare

Medicare appeal changes were implemented in 2005 that expanded providersí rights and guaranteed prompt responses to appeals as well as qualified, independent reviews at upper-level appeals. Limitations have been added, however, that apply to the presentation of new evidence in high-level provider appeals, so it is important to gather and reference all applicable information in the early stages of the appeal. Appeal Solutions provides an overview of important aspect of the Medicare Appeal process.


Topic Areas for Medicare:

Internal Medicare Compliance Oversight
Medicare offers a number of publications and tools to assist with compliance oversight. Make sure your medical billing staff has access to the following information. . . .more >>

Medicare Appeals Process
See our detailed information about the four levels in the Medicare Appeals Process. . . .more >>

Geriatric Treatment And Medical Necessity Issues
Geriatric care involves a number of unique issues which must be addressed in most Medicare medical necessity appeals. See our tips for assessing and discussion medical necessity in Medicare Appeals. . . .more >>