What must a provider do if they disagree with an adjustment after a discussion?

When a provider disagrees with an adjustment after having a discussion about it, initiating an appeals process is the appropriate course of action. This process allows the provider to formally contest the adjustment made to a claim, ensuring that any potential errors in the payment decision can be reviewed and rectified based on documented evidence and justification.

The appeal process typically involves gathering the necessary documentation and submitting a request for a reconsideration of the claim to the insurance payer. This might include evidence to support the need for the service provided, clarification of the coding used, or any additional information that could influence the payer's decision.

File a cancellation request would not address the disagreement regarding the adjustment. A cancellation would imply that the provider is retracting the claim, which does not resolve the issue of the adjustment itself. Similarly, submitting a new claim for review is not appropriate as it doesn't contest the previous adjustment directly; it may just initiate a fresh review without addressing the underlying disagreement. Changing billing practices may be relevant in the long term if adjustments consistently reflect issues in those practices, but it does not convey an immediate response to a particular dispute.

Therefore, initiating the appeal process is essential to ensure that the provider has a chance to present their case effectively and seek a resolution.