Here’s how end-stage renal disease facilities can appeal audit findings

Non-hospital end-stage renal disease facilities that receive a Blue Cross Blue Shield of Michigan ESRD initial audit reporting letter have the option of accepting or appealing our audit findings.

Included with the reporting letter will be the Appeal Process Option – Non-Hospital form. You should complete the form and fax it to Blue Cross at 1-877-276-3920 within five days of receiving the letter.

How to appeal
If you don't agree with our audit findings, submit the following documentation to Blue Cross (address included in the letter) within 30 days of receiving the letter:

• An appeal letter or statement for each patient, including:
  
• The reason for the dispute — for example, we received incorrect payment or we disagree with the number of dialysis treatments denied
  
• The rationale to support your position
  
• A Request for Retrospective Review form
  
• This form is now included with the audit-reporting letter.
• Complete all fields to expedite the appeal process.

Documentation
The documentation necessary to submit an appeal for an ESRD appeal is as follows:

• Physician orders — A valid physician order for the audit period in question, indicating the frequency of dialysis treatments per week
• Dialysis or treatment logs — For each month of appealed services, regardless of the location where dialysis occurred, submit a dialysis or treatment log so we can verify that you performed the number of treatments billed to Blue Cross.
• Patient’s name and dates of service being appealed