How to get reimbursed millions from Medicare Advantage denials

 Introduction

Get reimbursed millions using the Medicare Advantage Provider Compliant Form.

Reimbursement Tips

Get reimbursed millions using the Medicare Advantage Provider Compliant Form. I will give you some tips. The first tip is to make sure all the Medicare Advantage Plans appeal levels have been exhausted. This is very important because when filing the grievance form you must show you have attempted to resolve the appeal. The second tip is to review the Medicare Advantage plans reimbursement policies and procedures that will be challenged. The third step is checking CMS.gov LCD and NCD policies to support your claim that the service is payable. The fourth step in the Medicare Reimbursement process is submitting the CMS Medicare Advantage Provider Grievance Form. This will allow you to submit the last 12 months of Medicare Advantage Plans denials. Hypothetically, your organization has 88 denials average expected payment is $36,000 x 88 denials recovered equals $3.2 million potential recovery. Medicare Advantage Grievances Specialist (MAGS) can help you pursue those dollars.

Conclusion

In the past few years, there has been a recent drive for increased regulation of Medicare Advantage plans, notably concerning their prior authorization methods. This movement is a direct result of concerns about rampant denials. In an effort to improve the transparency and fairness of the rejection and appeals procedures for beneficiaries, the Centers for Medicare and Medicaid Services (CMS) has just released new rules.

Medicare Advantage Plans have historically denied millions of claims that are payable. Medicare Advantage plans are negatively impacting hospital facilities, even causing some hospitals to close their doors. Read this article about Medicare Advantage denials. By repeatedly denying claims, Medicare Advantage plans threaten rural hospitals and patients, say CEOs.

Regardless, if your facility has cut ties with Medicare Advantage Plans you can still use the Medicare Advantage Provider Grievance Form to recover denials that are payable. For a free consultation, please contact the Medicare Advantage Grievances Specialist (MAGS)