Managing Medicare Appeals

Fleming-AOD Consulting can assist providers with all levels of the payment denial appeal process. Although the process is presented as a linear series of events, we can tailor the engagement to match the specific requirements of your hospital.


  • Assist with drafting appeal letters

  • Analyze documentation to recommend medical necessity improvements

  • Prepare defense for each level of appeal

Process (any or all of the following can be included in your engagement)

Site Visit

  • Perform a program review of operations, admissions process, and IRF-PAI completion

  • Audit charts to reveal documentation and opportunities for coding improvement

  • Recommend documentation strategies for resistance to audits

Deliverable: Written report on chart audit findings, opportunities, and recommended actions

Redetermination appeals packet

  • Prepare appeal letters for denied claims

  • Create a sample letter for the beneficiary to send to CMS in support of the facility and encourage them to write their congressional representatives

  • Create a sample letter to send to the referring physician to get them to write CMS in support of the patient's admission to your facility

  • Analyze your MFI/RAC's overturn rate at redetermination

Deliverable: Appeal letter and template for use with future denials

Reconsideration appeals preparation

  • Prepare appeal template and letter

  • Conduct an analysis of the QIC's overturn rate at reconsideration

Deliverable: Appeal letter and template for use with future appeals

ALJ Preparation

  • Format documentation to present to the ALJ

  • Review prepared documents with staff and physician

  • Conduct an analysis of the ALJ's overturn rate

  • Provide appeals training and staff education

Draft letters
Implementation-ready appeals process
Coaching and training

What other programs does Fleming-AOD Consulting offer? »

Contact us to learn how our expertise can benefit your organization



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