Physicians and their associated practice groups serve as the backbone of our health care system. Both primary care physician – the “gatekeepers” – and specialists play an important role in serving the sick, elderly and disabled. However, this does not foreclose Medicare contractors from conducting extensive auditing of physicians and practice groups. While auditors tend to focus on basic E/M codes for general practice physicians, cardiologists, oncologists, psychiatrists and urologists, among others, are also subject to medical review for the codes pertinent to their specialties. Often times, contractors allege that a provider’s documentation does not support the level or type of service billed or that other technical requirements have not been met. They may also allege that the medical necessity of such services is in question. When these kinds of issues arise, a provider may very well want to appeal an adverse determination.
Experienced Medicare appeals counsel can assist providers in going through the Medicare appeals process. Call Liles Parker today to discuss your case.