CMS plans November 'town hall' on Medicare denial appeals

CMS has announced plans to hold a so-called "town hall meeting" in November to share information on appeals of Medicare payment denials. While CMS intends to address denials under Section 935 of the Medicare Modernization Act, the information officials provide should also be useful for dealing with RAC cases, consultants say.

Changes to section 935 of the MMA, which were published in mid-September, set up a new option for healthcare providers who choose to appeal a Medicare denial. The new approach postpones CMS from recouping denied funds when certain criteria are met. In short, it buys providers time.

The new rules under Section 935 give providers 41 days to bring a first-level appeal of a denial, and 60 days to submit a second-level appeal before a Medicare contractor can begin taking money back. Better yet, CMS must pay interest on accounts if providers overturn the denial at the third-level appeal or above.

To learn more about the meetings:
- read this RAC Monitor piece

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