Long-Term Care

The Medicare appeals process has become a logjam

Billing Alert for Long-Term Care, August 1, 2014

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The Medicare appeals process today continues to be challenged by an ever-increasing number of appeals and insufficient resources. Providers and suppliers believe that to receive a proper and complete adjudication of their claims for Medicare payment, cases need to be appealed to the Administrative Law Judge (ALJ) and Medicare Appeals Council levels of review. It is at the ALJ level that a provider or supplier can present expert testimony regarding the medical condition of a beneficiary, as well as explain medical records and related documentation supporting payment of a claim. The following issues are typically adjudicated at the ALJ level:

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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