Medicare & Medicaid

New Process for Appealing Medicaid MCOS’ Adverse Claim Determinations

House Bill 492 – New Process for Appealing Medicaid MCOs’ Adverse Claim Determinations On June 7, 2017, Louisiana House Bill 492 (HB 492) was sent to the Governor for executive approval. This Bill establishes a …..

2024-07-09T17:00:38-05:00June 16th, 2018|Categories: Medicare & Medicaid|Tags: |

Final 60-Day Rule for Reporting and Returning Overpayments

Quantification Required as Part of “Identifying” and Overpayment Six years after issuing its Proposed Rule, CMS released its final 60-Day Rule for reporting and returning overpayments. The Final 60-Day Rule is more industry-friendly, but still …..

2024-07-09T17:18:34-05:00July 14th, 2016|Categories: Health Law, Medicare & Medicaid Payment Rules|Tags: , |

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 …..

2024-07-10T17:04:37-05:00August 1st, 2015|Categories: Health Law, Medicare & Medicaid|Tags: |

The Affordable Care Act and Closing the Prescription Benefit Coverage Gap

(“Doughnut Hole”) Medicare Part D Coverage Gap Under the Medicare Part D Prescription Drug Benefit, many Medicare beneficiaries have annually encountered a large gap in their prescription drug coverage that is commonly referred to as …..

2024-07-10T17:44:46-05:00October 8th, 2013|Categories: Health Law, Medicare & Medicaid Enrollment, Provider Operations|Tags: |
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