Documentation Essentials Part 08: Navigating the Denials and Appeals Process


All therapy services provided to a Medicare B beneficiary under their benefit are subject to the scrutiny of Medicare as the payor. Some claims are paid, some are not. This course will assist therapists in understanding how to navigate the appeals and denials processes when a claim for services provided to a Medicare B beneficiary has been denied by the Medicare Approved Contractor (MAC), fiscal intermediary or carrier.

Course Goal and Learning Objectives

To provide a guide through the Medicare B appeals process.

Upon completion of the course the participant will be able to:

  • Identify the five (5) levels of appeal for a Medicare B therapy claim
  • Identify the three (3) forms used at each level and the criteria identified by CMS that needs to be present in order to proceed with the appeal
  • Identify three (3) documentation strategies that can be used to help optimize your chance of appeal of the denial decision.

Click here for information about the Course Instructor, our consultant/subject matter expert and contributing author.