APPEALS / ALJ's

Here are some benefits of why we do what we do Best…..

• We plan, step-by-step, for each of Medicare’s appeals levels
• We comply with strict rules on when you can present your evidence during the appeals process
• We Know when it makes sense to pursue an appeal, and when it doesn’t
• We Understand the role of the Qualified Independent Contractor (QIC) and how to request them
• We are experts at “Gleaning” through the patient’s chart so we can recognize what needs to be submitted. A lot of providers will send entire medical record chart, not realizing how to pick out what Medicare is really looking for and how to apply it to the entire appeals process
• We realize the adversarial role your carrier – and even CMS – may play in your appeals
• We are familiar with when you can automatically escalate an appeal to the next level – even when a decision hasn’t been made
• Most provider offices don’t know have the knowledge to be able to recognize what Medicare is asking for and what needs to be submitted.
• We are experts that know when to request a review, if denied again, when to request a QIC, and finally when to request an ALJ. Knowing the complete details of these processes and what is necessary to complete them is what provides for the best determination.
• Knowing how to do a complete ALJ is one that takes extensive time and knowledge
• We also handle appeals on the commercial side of business
• We know how to handle second level appeals
• We specialize in the guidelines of ERISA (Title 29) and the penalties of ERISA if the payer doesn’t comply.
• We specialize in person appeals and teleconference appeals