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Improve Revenue and get paid faster with reliable medical billing services by Ebiometronics along with Medical Transcription Services and Free CMS certified EMR.
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Medical Billing Services
How to appeal a Claim Denial?
Medical Billing Services in Medical Domain Medical Billing Services has a very crucial role in the
Medical Domain. It is basically a payer-provider interaction practice where a medical doctor works as a health care provider and the payer are generally Insurance Companies. Most of the people have their insurance for health, patients take medical services from the doctor and payment of the services is done by the respective insurance company.
But dealing with insurance companies is not simple job at all. So many process are involved in a claim submission and it’s approval that can’t be handled by a physician as they don’t have enough time to deal with insurance companies. Therefore, Outsourcing Medical Billing Services to a billing company is preferred.
Claim Denials by Insurance Companies
How to appeal a Claim Denial???
First Step:Redetermination
A redetermination is a process where FI, carrier, MAC personnel again examines the claim. These personnel are different from the ones who made the first claim determination.
Second Step:Reconsideration
The team of redetermination may request a reconsideration appeal further if the redetermination team is not satisfied with the redetermination decision. In such cases a Qualified Independent Contactor again conducts reconsideration.
Third Step: Heating by Judge
A hearing by an administrative Law Judge is conducted by the Office of Medical Hearings and Appeals only when the Qualified Independent Contractor decision comes out in favor of the appellant then the reconsideration party may request the judge hearing within 60 days of receiving reconsideration decision.
Fourth Step: Review by the MAC: This step is taken when the party to a
judge’s hearing is not satisfied with his/her decision then the party may send a request Medicare Appeals Council to review it.
Final Step: Judicial Review
Even after the decision of Medicare Appeals Council, the controversy exists then the party has a right to request a judicial review before a Federal District Court Judge within 60 days.
Medical Billing ServicesBy Ebio-Metronics…!
Medical Billing Services
Improve Revenue and get paid faster with reliable medical billing services by Ebiometronics along with Medical Transcription Services and Free CMS certified EMR.
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