Denial Process Education & Training
Every year, Medicare denies millions of SNF claims, leaving SNF providers with billions of dollars to reconcile. While the appeals process can be complicated and time-consuming, those who press their cases enjoy relatively high success rates.
Harmony Healthcare International (HHI) educates SNF providers on the step-by-step appeals process for Medicare claims.
If an initial appeal is not successful, do not give up or be discouraged. Typically, each appeal can be tried five times. At each successive level, a different entity, including an independent contractor and an administrative law judge hears the case. The final appeal takes place in a Federal District Court.
HHI Denied Claims experts have devised protocols, strategies and successful tips for managing this process within the SNF setting. The HHI tools can be presented per facility preference either in person at the facility, at the state off the art training center located at the HHI corporate office or via web based training modules.
Potential Risk to Providers:
Providers should determine early whether or not it is worthwhile to go through the appeals process. Often times, the opposing opinion is, "I am not going to spend $5,000 pursuing an appeal for $1,000." The big picture is that it is not just an issue of one claim. Facilities must consider the value of all the claims being submitted for payment for the next few years.
The most important thing providers can do to avoid Medicare denials is to implement sound claim procedures and documentation standards and to know when and what kind of evidence to submit.