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Medicare Appeals – Limiting the Scope of Review on Redeterminations and Reconsiderations of Certain Claims

CMS recently provided direction to A/B MACs and QICs regarding the scope of appellate review for redetermination (1st Level) and reconsideration (2nd Level) appeals of certain claims. Historically, MACs and QICs had discretion while conducting …..

August 1st, 2015|Categories: Health Law, Medicare & Medicaid|Tags: |

OIG Issues Additional Compliance Guidance Emphasizing Responsibility of Governing Boards

A Hospital’s commitment to effective statutory and regulatory compliance starts at the top with the Hospital’s Governing Board. On April 20, 2015, the Office of Inspector General, U.S. Department of Health and Human Services (“OIG”) …..

April 30th, 2015|Categories: Health Law|Tags: , |

Automatic Denial Authority for “Related claims” – REDUX

CMS Provides MACs, CERT, RACs, and ZPICs with Automatic Denial Authority for “Related claims” – REDUX You may recall earlier this year, CMS issued a Transmittal giving MACs, RACs, CERT contractors, and ZPICs discretion to automatically …..

August 8th, 2014|Categories: Health Law|Tags: , |

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