Medicare Appeal Letter

• SHARE
• 
• 
• 

Medicare is the insurance the U.S. government provides for individuals who are aged 65 and older. Over the years Medicare reimbursement rules have become increasingly stringent. Physicians, hospitals and insurance billers have to be extremely careful to get pre-approval from Medicare for procedures and use all of the proper codes when billing for those procedures. When Medicare refuses to pay a claim, the patient or the provider can write a Medicare appeal letter.

Format and Content

The Medicare appeal letter format should include the beneficiary’s name, their Medicare health insurance number, the claim number and specific item or service that is associated with the appeal, dates of service, name and location of the facility where the service was performed and the patient’s signature. It is a good idea to be prepared to provide medical records to the Medicare representative who is researching your appeal as well as a letter from the physician who performed the procedure. In addition, find out the name of the person to whom the letter should be addressed as well as the proper department and address.

Sample

Coding is very important in the submission of Medicare claims and incorrect codes can send the process into a tailspin. This Medicare appeal letter sample is from a patient whose provider inadvertently left a code off of her bill causing the claim to be denied. She has obtained a corrected bill from the provider with the missing code added and is appealing to Medicare to pay the corrected claim.