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What Are... Medicare Appeals? Second Edition
| Clasificación: | Libro Electrónico |
|---|---|
| Autor principal: | |
| Otros Autores: | |
| Formato: | Electrónico eBook |
| Idioma: | Inglés |
| Publicado: |
La Vergne :
American Bar Association,
2022.
|
| Temas: | |
| Acceso en línea: | Texto completo |
Tabla de Contenidos:
- Intro
- Title Page
- Copyright Page
- Contents
- Introduction
- About the Authors
- Chapter 1 Medicare Part A and Part B Audits
- A. Comprehensive Error Rate Testing (CERT) Audits
- B. Medicare Administrator Contractor (MAC) Audits
- Targeted Probe and Educate
- Post-payment and Pre-payment Medical Reviews
- C. Supplemental Medical Review Contractor (SMRC) Audits
- D. Recovery Audits
- E. Unified Program Integrity Contractor (UPIC) Audits
- Chapter 2 Overview of the Medicare Part A and Part B Appeals Process
- A. Stage 1: Redetermination
- Recoupment during Redetermination
- B. Stage 2: Reconsideration
- Recoupment during Reconsideration
- C. Stage 3: ALJ Hearing
- ALJ Backlog and Resolution
- Statistical Sampling Initiative
- Settlement Conference Facilitation Pilot
- D. Stage 4: Medicare Appeals Council (the "Council") Review
- E. Stage 5: Federal District Court Review
- Chapter 3 Legal Challenges to Part A and Part B Audit Determinations
- A. Advocating the Merits
- B. Treating Physician Rule
- HCFA Ruling 93-1
- C. Waiver of Liability
- D. Provider without Fault
- E. Challenges to Statistical Extrapolations
- Medicare Prescription Drug, Improvement and Modernization Act
- Challenges to the Validity of a Statistical Sample
- Resources and Reference Materials
- A. ABA Health Law Section Resources
- B. Government Resources
- C. Statutory, Regulatory (i.e., Code of Federal Regulations ("[CFR]")), and Sub-Regulatory Guidance Citations Related to the Medicare Part A and Part B FFS Appeals Process and Medicare Audits
- D. Statutory, Regulatory, and Sub-Regulatory Guidance Citations Related to the Medicare Part A and Part B FFS Related to Legal Challenges to Medicare Audit Determinations
- Index