Corporate Compliance

Note: Appeals council issues a "partially favorable" decision

Medicare Insider, March 30, 2010

Want to receive articles like this one in your inbox? Subscribe to Medicare Insider!

Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

The Medicare Appeals Council has issued a decision on one of the many outstanding appeals from the RAC Demonstration Project.  This is of particular interest because the RAC’s revised initial determination on one particular claim stated that the provider had received an overpayment for the inpatient services but the beneficiary met the criteria for outpatient observation. The Administrative Law Judge’s (ALJ) decision was "partially favorable" to the provider and it stated that payment should be made under Medicare Part B for those services that cannot be made under Medicare Part A.  CMS went on to appeal the ALJ’s decision.

Continue reading Debbie Mackaman's note.



Want to receive articles like this one in your inbox? Subscribe to Medicare Insider!

Most Popular