Medical Billing: How to Appeal a Rejected Medicare Claim
The Centers for Medicare & Medicaid Services (CMS) has a defined process for appealing a rejected medical billing claim. This process is easy to follow and quite efficient. You can find all the necessary forms at the Medicare website and individual contracted Medicare carrier websites.
The preferred method for submission is online. You can also submit additional documentation as well. The Medicare online appeal site provides a cover sheet that you can use to mail or fax the documentation to the appropriate address for consideration.
Medicare tends to see everything as black and white and makes all decisions based on the policies that were in effect on the service date. So as long as you or your software stays current with regard to Medicare policy, then appealing to this payer is quite painless.
The request for redetermination is a friendly reminder that the Medicare processing does not reflect the local fee schedule. You can find the initial request form at the Medicare website. Most Local Coverage Carriers or Medicare contractors have links to this form on their individual websites, and many allow the appeal to be submitted online with supporting documents faxed, using the assigned cover sheet.
Submit online if possible to avoid any potential timely appeal issues. According to Medicare rules, an appeal must be submitted within 90 days of the initial determination. If you submit online, you have proof of timely submission.
If the contractor doesn’t grant your request or provide solid evidence that the claim has already processed correctly, the next level of appeal is to a Qualified Independent Contractor.
A resume format that includes a comprehensive biographical statement of three to ten pages. This resume format emphasizes professional qualifications and activities.
A variation of the hybrid resume that includes qualifications and accomplishments.
A document signed into law that makes it illegal for an employer to discriminate against (or refuse to hire) a person simply because that person has one or more disabilities.
A software application that helps a company recruit employees more efficiently. Includes features to post job openings online, screen resumes, acknowledge the receipt of resumes, and generate interview requests.
A type of job interview in which candidates are asked what kinds of behaviors they have used in the past to handle certain situations and solve problems.
A Web-based journal that is written and updated by one or more blog writers, or bloggers. Today's more sophisticated versions read like media stories and columns.
A marketing tool for job seekers consisting of a brief statement that communicates who you are in the workplace; typically used in resumes and job interviews. Also sometimes called a branding brief.
Self-marketing letters that a job seeker sends to a large but carefully targeted list of potential employers. These letters are designed to uncover an opportunity in the hidden (unadvertised) job market.
A family of job letters that are self-marketing tools for people who want to be hired for the best jobs. Includes job ad reply letters, broadcast and prospecting letters, resume letters, follow-up letters, and e-mail cover notes.
A resume style that focuses on the skills and talents needed to be able to perform a particular task to a certain standard. Connects your behaviors with your accomplishments.
A starting resume that you use as a base or template to spin off targeted versions of your resume (for specific positions) when you must move quickly.
A self-marketing document designed to sell yourself and get an interview for a specific job; typically accompanies a resume.
Reports that contain your payment history to creditors. These reports may also include names of previous employers, residential stability data, divorce information, and estimated prior earnings.
A type of job interview in which the interviewer maintains complete control and walks you through the discussion to uncover what he or she wants to know.
Equal Employment Opportunity Commission. The EEOC is a U.S. federal agency that investigates discrimination complaints.
Electronic form. An online form, such as a job application form typically found on company Web sites. You enter data within fields of the form.
An e-mail message that introduces a resume that you distribute online. Typically, a shortened and more informal version of a cover letter.
Electronic resumes. Resumes that you distribute online.
A complete character set comprised of a single size and typeface, such as 12-point Helvetica.
The height of the characters in a font set, measured in points, such as 10-point or 14-point. One point is equal to 1/72 of an inch.
A skills language used in cover letters to communicate your expertise in fundamental job skills — includes basic skills, people skills, thinking skills, and personal qualities.
A resume format that focuses on portable skills or functional areas and ignores chronological order. This resume format works well for career changers, new graduates, ex-military personnel, work-history gaps, or special-issue problems.
A resume format that is a combination of the reverse chronological resume format and the functional resume format.
A real-time form of communication between two or more people online, who type messages back and forth in a window. Job seekers can attach resumes to messages.
A test administered by a potential employer during the interviewing process that rates honesty, responsibility, and reliability for the job.
Work samples that you submit to a potential employer during the job interview process, such as portfolios, project materials, and proposals.
An excruciatingly detailed resume format used to apply for international jobs. This resume style is typically six to eight pages long and often uses the reverse chronological format.
A letter that is written in reaction to a published job opening in print or online.
A Web site that posts general or specialized job listings, such as CareerBuilder.com and Monster.com.
A resume format that places a profile of keywords at the top of a document. This resume format is not in common use today because current resume search databases can pick up keywords anywhere in a resume, not just at the beginning of a document.
Internet search words (generally nouns and short phrases) that identify your qualifications. Employers use keywords to search and retrieve e-resumes in databases for available job positions.
A resume format that flows one line at a time and relates achievements, winning moves, and star points in short, quick spurts; designed to attract the eyes of busy readers.
A personal commercial that you create to sell yourself during a job search. A marketing pitch should be about one to two minutes long.
An electronic resume that you place on a disc; generally sent by postal mail. This resume format is not in common use today.
A type of job interview where the interviewer's questions tend to be broad and general so that you can elaborate and tell stories about yourself and your qualifications.
Office of Federal Contract Compliance Programs. The OFCCP is an agency that tracks the diversity hiring record of those applying for positions with federal contractors.
A short profile (about 200 words or less) that is placed on social networking sites and job boards to advance employment or business objectives. Includes keywords and a link to a full resume.
A lengthy multi-link document that appears on Internet networking and career sites such as LinkedIn.com and VisualCV.com.
An e-mail job distribution method paid for by employers. This service helps you identify which of your contacts may know people at companies where you would like to work.
A form of pre-employment screening that verifies that you are a good fit for the position and that you haven’t lied about your background. May include online tests, assessment instruments, and questionnaires.
A type of job interview (also called a structured interview) in which the interviewer works from a written list of questions asked of all candidates and writes down your responses.
A test administered by a potential employer during the interviewing process that measures choice, preference, values, behavior, decisions, attitudes, and job-related interests.
A digital audio or video file that is available for downloading from a Web site. Usually available in a series that is often packaged like a daily newscast or commentary.
The process of creating and distributing audio and video feeds over the Internet. To make a podcast, you need a computer, microphone, Internet access, and recording software.
A collection of work samples often delivered as part of the job interview process for those in fields such as design, graphics, photography, architecture, advertising, public relations, marketing, education, and contracting.
A resume format that emphasizes professional qualifications and activities and is typically three to five pages long. This format is essentially a shortened version of the academic curriculum vitae resume format.
A type of interview that is conducted for an employee who is a candidate for a higher job position within the company.
Self-marketing letters that a job seeker sends to a relatively small and select number of potential employers. These letters are designed to uncover an opportunity in the hidden (unadvertised) job market.
An employers’ personal shopper, tasked with going into the marketplace and bringing back the best qualified candidates for the thriftiest prices.
A service that advertises their willingness to save you time and trouble by blasting your resume to thousands of recruiters and hiring managers all over the Internet — for a fee. These services are generally not recommended due to privacy and identity theft concerns.
A self-marketing document that combines a cover letter with a resume (the resume is not a separate document). This type of letter is typically two pages long, but can be one page.
A resume format that includes employment history from the most recent jobs working backwards, showing dates for employers and educational institutions. This resume format works well for those with a steady career progression.
An online service you subscribe to that sends immediate content updates (such as job postings that match a selected criteria) from selected Web sites to your computer or handheld device. RSS stands for Really Simple Syndication.
An employee (typically an administrative assistant or HR specialist) who monitors phone calls for a company when you call their main telephone line.
A first-cut job interview that is used to weed out all applicants except those who are best qualified for the position.
A job interview in which you meet with a supervisor, department head, or another person who has the authority to hire you.
An acronym for Search Engine Optimization. SEO is a method of using technical and strategic maneuvers to increase the traffic driven by search engines to a Web site.
A type of job interview in which you are typically passed from the initial screener to a line manager to a top manager — and perhaps a half-dozen people in between.
Web-based services — including discussion groups, message boards, e-mail, and blogs — that give users a way to find and interact with people who have similar interests. Some of this interactivity focuses on job search and recruiting.
Automated programs (software) used by specialized search engines to scrape (crawl) the Web to find and haul in content, such as job postings. Also called robots or just 'bots.
A type of job interview in which the interviewer intentionally uses various intimidation tactics to attempt to put pressure on you.
A resume that is customized for a specific employment goal or position in a job search.
A specific family of fonts in a similar design style (including multiple sizes of that font), such as Arial or Times New Roman.
Online search engines that search only for job listings, across multiple job sites at once. Examples include SimplyHired.com and Jobster.com. Also called verticals or aggregators.
A canned video interview in which a candidate speaks about his or her qualifications, goals, and strengths; sometimes called a video podcast.
A faint image ingrained in quality-stock paper. Resumes are commonly printed on paper stock that includes a watermark.
The second generation of Web design that uses sites in which people communicate and share information. Web 2.0 tools include blogs, instant messaging, podcasts, RSS feeds, and social networking services.
An electronic resume that you post on a personal Web site; also sometimes called an e-portfolio or HTML resume.