Appeals
A denial is not a decision
It is the first answer. There are five levels after it, and the practices that collect are the ones that use them before the clock runs out.
The clock
Miss a date and the claim is not delayed, it is gone. These are the deadlines we work to:
| Stage | Decided by | You have | They have |
|---|---|---|---|
| RedeterminationLevel 1 | Your Medicare contractor | 120 days to file | 60 days for an answer |
| ReconsiderationLevel 2 | An independent contractor | 180 days to file | 60 days for an answer |
| Hearing before a judgeLevel 3 | An administrative law judge | 60 days to file | 90 days for an answer |
The one that catches people: when a demand letter arrives, you have 120 days to appeal but only 30 days to appeal and stop the money being taken back in the meantime. Those are different dates, and the short one is rarely the one people diary.
What we actually do
Read the remittances. Every denial gets classified by reason, and sorted into appealable, fixable by resubmission, and genuinely dead. Most practices appeal the loud ones and never see the rest.
Build the argument from the record. The coverage rule, the documentation that satisfies it, and the specific point where the payer was wrong. Where the record does not support an appeal, we say so rather than filing anyway.
File, and escalate. A Level 1 refusal is not the end. Level 2 is a different reviewer, and Level 3 is a judge.
Tell you what it taught us. Denials repeat. If the same reason keeps appearing, the fix is upstream in documentation, not downstream in appeals — and that is worth more than the recovery.
Honest about the limits
We cannot win an appeal the documentation does not support, and we will not write one that says otherwise. What we can do is make sure every claim that should be appealed is appealed, inside the window, with the evidence that actually exists attached to it.
Send us a month of denials