What does AFIRM mean in UNCLASSIFIED
AFIRM stands for Appeal Fairness Integrity and Reforms in Medicare. It is a program created by the Centers for Medicare and Medicaid Services (CMS) to ensure that all appeals of coverage decisions made by Medicare are processed fairly and efficiently. AFIRM seeks to streamline the appeal process, reduce costs, and increase integrity in the system.
AFIRM meaning in Unclassified in Miscellaneous
AFIRM mostly used in an acronym Unclassified in Category Miscellaneous that means Appeal Fairness Integrity and Reforms in Medicare
Shorthand: AFIRM,
Full Form: Appeal Fairness Integrity and Reforms in Medicare
For more information of "Appeal Fairness Integrity and Reforms in Medicare", see the section below.
Essential Questions and Answers on Appeal Fairness Integrity and Reforms in Medicare in "MISCELLANEOUS»UNFILED"
What is AFIRM?
AFIRM stands for Appeal Fairness Integrity and Reforms in Medicare, which is a program created by the Centers for Medicare and Medicaid Services (CMS) to ensure that all appeals of coverage decisions made by Medicare are processed fairly and efficiently.
How does AFIRM work?
Under the AFIRM program, CMS has extended priority review status to certain types of appeals such as those involving critical care services or end-stage renal disease treatments. This ensures that these appeals are reviewed promptly upon submission. Additionally, CMS requires all Medicare Administrative Contractors (MACs) to assign an additional Quality Assurance representative when handling high-volume appeals cases so that decisions can be made more efficiently.
Who administers AFIRM?
The Centers for Medicare & Medicaid Services (CMS) is responsible for administering the AFIRM program. CMS works with MACs to ensure that all appeals are addressed properly and resolves any discrepancies between contract administrators in a timely manner.
Does AFIRM affect my coverage decisions?
Yes. Under AFIRM, priority review status is extended to certain types of appeals on a case-by-case basis, such as those involving critical care services or end-stage renal disease treatments, allowing these cases to be handled more promptly than other appeal cases. Additionally, MACs must assign additional Quality Assurance representatives when handling high-volume appeal cases so that decisions can be made more efficiently.
What happens if an appeal is denied?
If an appeal is denied after being processed under AFIRM guidelines, there may still be recourse available through external review or independent dispute resolution processes. These processes provide additional opportunities for resolution should the initial decision prove unsatisfactory.
Final Words:
The Appeal Fairness Integrity and Reforms in Medicare (AFIRM) program was established by the Centers for Medicare & Medicaid Services to ensure fairness in processing claims denial appeals while streamlining the process and reducing overall costs at the same time. Patients who have experienced denials can consider both internal reviews through their medical provider's office as well as external reviews if their internal review results in denials beyond what they deem reasonable or necessary for their care.
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