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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

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Appealing a Denial

Jan 28, 2019 / Article

CMS Targeted Probe and Educate Program

Dec 10, 2019 / Open Access

Additional Medicare Denials, Audits, and Appeals Content

CMS Corrects RTM Code Denials Made in Error

Apr 14, 2023 / News

APTA's outreach sparked the change, to be made official in July. Until then, denied claims should be resubmitted.

Noridian Audits Call for Documentation that Could Be Impossible to Provide

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.

Code Pairing Edits: Four Things To Know

Jan 25, 2021 / Article

APTA successfully advocated for CMS to lift misguided coding edits, and we're working to bring commercial payers around.

CMS Fast-Tracks 'Breakthrough Devices,' Clarifies 'Reasonable and Necessary'

Jan 19, 2021 / Review

CMS has finalized a new pathway that could result in quicker coverage of cutting-edge FDA-approved medical devices.

CMS Takes Aim at Prior Authorization in Medicaid, CHIP, and Federal Exchanges

Jan 19, 2021 / Review

The final rule pushes payers toward more transparency and consistent deadlines for decisions.

Understanding Targeted Probe and Educate

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.

CMS Offers Alternative Dispute Resolution for Some Providers With Unresolve...

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.

CMS MAC Claims Review Process Will Move to More Targeted System

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.