Ask the Experts: Medicare Adjustments During Appeals

Can we adjust a denied Medicare charge off of an account when an appeal is still open? The denial is the result of lack of medical necessity. 

Answer: Yes, I’ve seen clients do this—write-off charges while appeals are still pending—then reverse the write-offs if they win their appeals. It comes down to whether hospitals know claims may be denied, and if so, could they plan in advance with advance beneficiary notices (ABNs), or similar documents, from patients. That way, if claims are denied, patients understand their financial responsibilities. 

This question was answered by: Curtis H. Bernstein, CHFP, CPA/ABV, ASA, CVA, principal, Pinnacle Healthcare Consulting, and a member of HFMA’s Colorado Chapter. 

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