Medicare Appeal

CMS Issues New Instructions to its Contractors Regarding the Scope of Claim Appeals

Medicare, Medicaid & Private Payor Updates /

(October 15, 2015): In an effort to stem the ever-increasing tide of claim appeals, CMS recently issued new guidance (MLN Matters SE1521) to its Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the conduct of requests for redetermination and reconsideration, respectively. Effective 08/01/15, MACs and QICs may no longer review claims denied during […]

CMS Issues New Instructions to its Contractors Regarding the Scope of Claim Appeals Read More »

Medicare Administrative Appeals Process – An Overview for New Providers

Medicare, Medicaid & Private Payor Updates /

(August 15, 2012): Is this your first time being audited by a Medicare Administrative Contractor (MAC) or a Zone Program Integrity Contractor (ZPIC)? If so, the brief outline below can provide a handy summary of the Medicare appeals process. I. Step 1 – Request for Information: In most instances, a health care provider will receive

Medicare Administrative Appeals Process – An Overview for New Providers Read More »

Lose Your Appeal at Reconsideration? Consider an ALJ Hearing

Medicare, Medicaid & Private Payor Updates /

(June 18, 2011): As a review of the last several quarters of Medicare appeals statistics reflects, an overwhelming percentage of Medicare providers appealing alleged overpayments through the Medicare administrative appeals process have chosen to “throw in the towel,” so to speak, when they have lost at the reconsideration level. As you will recall, at the

Lose Your Appeal at Reconsideration? Consider an ALJ Hearing Read More »