New Electronic System for Provider Reimbursement Review Board (PRRB) Appeals

Y
ou are not sure what we will be discussing about?

Is it – You want the complete context to be covered to the fullest potential?

If you answer yes, we have now got you all covered.

Whether you are new to the update or just getting a refresher, which just depends on the level of information you want to have things rolling in positively if you are a Part A Provider, Medicare Contractor, or other PRRB Stakeholder.

To make the context completely sensible and understandable, let’s discuss what is what:

Part A Providers
When it comes to providing Inpatient Care in the Hospital, Skilled Nursing Facility Care, including Hospice as well as Home Health Care, Part A Providers comes into the picture.

Medicare Contractors
You can call Private Health Care Insurer Medicare Contractor. The best of everything – They manage to process Medicare Part A and Part B (A/B) Medical Claims, including Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.

PRRB Stakeholders
Those who directly involve in PRRB Electronic Filing and make things go as expected and required complying with the statutory norms and regulations, PRRB Stakeholders take the courage to go hand-in-hand.

Now, it has become completely viable to discuss the guide more thoroughly, getting every equation keeping forth for a constructive understanding and reasoning.

Now, let’s discuss what is Provider Reimbursement Review Board (PRRB)?
Any Medicare Contractor or the Centers for Medicare and Medicaid Services (CMS) can release final determinations. If such determinations are not favorable and intended to satisfy Certified Medicare Providers, they have got the rights to approach Provider Reimbursement Review Board (PRRB) as it’s an independent panel for the resolution.

Along the same lines, PRRB publishes its rules, current alerts, final substantive and many other jurisdictional decisions to take a look at.

With that being said – Here’s the next question that comes up straight.

Why would any Certified Medicare Provider would approach and seek Provider Reimbursement Review Board (PRRB) involvement?
When it comes to intervening and resolving appeals as well as claims due to improper Medicare Payment to Health Care Institutions and Providers, it becomes a necessity to contact and seek Provider Reimbursement Review Board for its involvement.

Following everything – Now, we are going to share a good update.

It’s one of the biggest breakthroughs that the Department of Health and Human Services (HHS) has finally decided and worked upon to creating a new E-Filing System to speed up such appeals and claims.

Well, the system works amazingly seamless for Hospitals & Other Medicare Part A Providers, further settling beneficiary appeals or claim disputes down further in the most unbiased and clearest manner possible.

You can call E-Filing System or New Electronic System – OH CDMS.
Let’s discuss the benefits for a leveraged understanding.

First of all, OH CDMS’s full form is – The Office Of Hearing Case & Document Management System.

It’s a web-based portal that can allow Health Care as well as Part A Providers to submit claim appeals or disputes they felt affected from.

Below are the benefits of OH CDMS:

  • You can manage and view disputes and appeals at a glance
  • You have 24/7 real-time access
  • The interface is super cool and worth the efforts
  • For every development, notices as well as decisions, parties as well as designated representatives are easily notified
  • If there’s any new case, the opposing party gets the best view over!
  • The best of everything – You get system-generated confirmations, including portal-based submissions
  • Now, there’s no need to send a separate copy of the correspondence to any relevant contractor at all

Just the pretext:
Initially, it was least to impossible to the Department of Health and Human Services (HHS) to look and work around numbers of Medicare Reimbursement Disputes.

The situation was uncontrollable and dense to take over.

Well, when final determinations were laid out, Medicare Contractors, PRRB Stakeholders as well as Part A Providers felt helpless and found unresolved with their appeals and claims.

That’s how the Department of Health & Human Services (HHS) took things on radar and introduced the New Electronic System for Provider Reimbursement Review Board (PRRB) Appeals.

So, when you can approach the Department of Health and Human Services (HHS) for?
The answer is when:

  • You are not satisfied as a Medicare or Health Care Provider with the final determinations CMS or a MAC has rolled out
  • You should be able to demonstrate the amount that you are appealing or putting the claims for is minimum $10,000 or more (or $50,000 for a group)
  • Last, but not the least – You should just manage to file a request within 180 days for a hearing from the date the final determination gets flouted out

About Us:
Thus, as a Health Care Institution or Clinic, it’s always important to have a Medical Billing and Coding Solutions at hand. Whether you got impacted and didn’t get pay back for the health activities under Health Care Programs, that’s when raising concerns as well as necessary appeals become the toughest job possible. Thus, we always recommend you to contact us at Monarch RCM to ensure you are all covered and given the best resolutions. We always make sure our customers are satisfied and experience seamlessness through Medical Billing & Coding Solutions we provide at large. Do contact us, today!
Final Thoughts
So, ultimately – It’s a relief to cut off cumbersome manual appeals and claims.

HHS has significantly altered the best versions and made sure things go systematic and in the best possible manner.

With that being said – We would like to know what are your thoughts about the guide!

Do comment, and on a sweeter note – Thanks for the read, though!