Medicare and Medicaid: Dissimilar Programs, Different Provider Appeal Processes, Same Pain

ICD10monitor November 19, 2025
Knicole C. Emanuel Esq.

Medicare and Medicaid audits differ in process. Yet one thing remains the same, in practice: the administrative process has become so burdensome that many providers quietly decide it is safer to stop treating Medicare and Medicaid beneficiaries altogether.

Which appeal process is easier? Which appeal process costs more in attorneys’ fees, wasted internal time, and burden? Let’s go through each process.

For providers, it’s not just the audit that hurts; it’s the appeal process that follows.

Medicare is a federal program administered by the Centers for Medicare & Medicaid Services (CMS), but audits are farmed out to a patchwork of contractors. Medicare Administrative Contractors (MACs) conduct claims processing and post-payment reviews; Recovery Audit Contractors (RACs) are contingency fee hunters focused...

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