There are five levels in the Medicare Part A and Part B appeals process.
The levels are:
- First Level of Appeal: Redetermination by a Medicare Administrative Contractor (MAC)
- Second Level of Appeal: Reconsideration by a Qualified Independent Contractor (QIC)
- Third Level of Appeal: Decision by the Office of Medicare Hearings and Appeals (OMHA)
- Fourth Level of Appeal: Review by the Medicare Appeals Council
- Fifth Level of Appeal: Judicial Review in Federal District Court
Did You Know that HHS/OIG Found
When beneficiaries and providers appealed preauthorization and payment denials, Medicare Advantage Organizations (MAOs) overturned
75 percent of their own denials
We help Providers successfully navigate the appeals process without disrupting all other business
workflows while assuring they receive all entitled reimbursement and due process
Don’t let denied claims be a time and resource drain. Often, the time and resources required for appeals disrupts other essential workflows. Take the burden of appeals out of the equation to maintain peak efficiency.
Let our team of Appeals Professionals remotely conduct successful appeals from the cloud. Seamlessly and cost effectively recover the revenue your organization is entitled to.
Our team is comprised of Appeals Specialists that understand the appeals process end to end and have the depth of experience to handle your appeals with precision. Appeals are considered based on facts and circumstances that must be presented in compelling form to be successful. This is where our experience makes all the difference.
Tools and Resources
“The right tool for the job” Appeals are a specialized knowledge base. There are policies and procedures that can make or break the outcome. From deep knowledge of guidelines and regulations to Best Practices, use the right tool to get the just result.
Our services are overseen by out founder Douglas Palmer who has deep expeerience and success, as well as accolades, being involved in Appeal Adjudication. The invaluable experience of being the decision maker on appeals makes us a logical choice for conducting appeals. It is our fabric. From compliance to strategy, there is simply not a better choice for your appeals needs.