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Denials happen. So do successful appeals.
The Centers for Medicare and Medicaid Services has attempted to refine its processes over the years, but denials are still disruptive and potentially time-consuming. It's important for you to understand Medicare's approach to refusing or questioning payment, because that knowledge can help inform and strengthen your appeal should you decide pursue that option.
Questions about denials, audits, and appeals? Contact us at advocacy@apta.org.
Recommended Content
Jan 28, 2019 / Article
APTA provides general tips and a suite of templated letters that can help you make your case for an appeal.
Dec 10, 2019 / Open Access
The CMS Targeted Probe and Educate program provides one-on-one assistance to reduce claims denials and appeals.
Additional Medicare Denials, Audits, and Appeals Content
Apr 14, 2023 / News
APTA's outreach sparked the change, to be made official in July. Until then, denied claims should be resubmitted.
Jan 31, 2022 / News
The notices being sent to PTs ask for records more in line with inpatient facilities. Here's what we know — and tips on how to respond.
Jan 25, 2021 / Article
APTA successfully advocated for CMS to lift misguided coding edits, and we're working to bring commercial payers around.
Jan 19, 2021 / Review
CMS has finalized a new pathway that could result in quicker coverage of cutting-edge FDA-approved medical devices.
Jan 19, 2021 / Review
The final rule pushes payers toward more transparency and consistent deadlines for decisions.
Jul 1, 2018 / Column
This CMS program is designed to help providers and suppliers reduce claim denials and appeals. Here's what to know if you're contacted.
May 15, 2018 / News
Providers with Medicare Part A or B appeals that have been waiting for a decision are being offered a new option.
Aug 21, 2017 / News
CMS will move away from its current practice of randomly selecting claims for audit in favor of a more targeted approach that it hopes will streamline the process and result in fewer appeals.