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New guidance follows a report to CMS by the OIG on Medicare Advantage Organization’s inpatient clinical criteria in denying claims. EDITOR’S NOTE: This story is
The Medicare Providers Appeals process runs counter to the American judicial process. In litigation, there are two opposing sides, as in football. It wouldn’t be
Provider frustrations over getting to the third level of appeal can be downright Shakespearean in scope. “Get thee to a nunnery!” Hamlet tells his sister,
Providers are finding success when arguing their case before an ALJ – and finding trouble beyond that point. I have been handling appeals of extrapolated
With an expected ramp-up in audits and denials for care across all healthcare services in the coming months, we continue to hear questions related to
Coding must be supported by documentation, but also by the Official Coding Guidelines. While preparing for a clinical validation presentation on acute kidney injury denials,
As Virginia Medicaid behavioral healthcare providers are being terminated, the question remains, is it legal. EDITOR’S NOTE: The opinions expressed herein are exclusively that of
Refund only after careful thought. The risk of rushing to refund: not only is it alliterative, it is real. The proper desire to be compliant
CMS agrees to settle appeals for IRF facilities following a two-year disputed with the industry. The Centers for Medicare & Medicaid Services (CMS) has announced
Suggestions for conducting peer-to-peer appeals for denials If you are wondering why you should read this if you think you are not a rebeginner, well,
“Urgent” memo marks obvious disagreement among contractors. In what can only be described as highly unusual, a Medicare Administrative Contractor (MAC) has advised home health
Plaintiffs are the American Hospital Association and three other regional hospitals and healthcare systems. Providers with Medicare appeals pending may have their claims resolved sooner
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