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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.


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Appealing a Denial

APTA provides general tips and a suite of templated letters that can help you make your case for an appeal.

CMS Targeted Probe and Educate Program

Open Access


Additional Medicare Denials, Audits, and Appeals Content

CMS Corrects RTM Code Denials Made in Error

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

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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

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'

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

Review

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

Understanding Targeted Probe and Educate

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.