Medicare Fee Schedules are not appealable

Medicare has released a notification stating that they are receiving a higher volume in appeal requests for services which Medicare paid the claim appropriately based on the set allowable fee schedule.

WPS Medicare wants medical providers to understand that for those who noticed the fee schedule change resulted in a payment reduction and are attempting to appeal that this is not an appealable option.

Per the Centers of Medicare and Medicaid Services (CMS) internet-Only Manual (IOM) Publication 100-4, Chapter 29, Section 200 C (3). This section states, Actions that are not initial determinations and are not appealable under this the Chapter include, but are not limited to, "Any issue regarding the computation of the payment amount of program reimbursement of general applicability for which CMS or a carrier has sole responsibility under Part B, such as the establishment of a fee schedule set forth in 42 CFR, part 414, subpart B or an inherent reasonableness adjustment pursuant to 42 CFR 405.502 (g).:

Please refer to the CMS IOM 100-4, Chapter 29 regarding appeals at the following Website address:http://www.cms.hhs.gov/manuals/downloads/clm104c29.pdf

Medical billers/collectors please forward this information on to your providers that bill to Medicare so they are aware of these changes. When they ask you to "collect" more on these fee schedules you will be able to explain why you can't.

Good Luck and Happy Billing!

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