OIG issues review of Medicare appeals at the Administrative Law Judge level
Recovery Auditor Report, November 29, 2012
On November 15, the OIG issued a review of ALJ appeals decided in fiscal year 2010. The study was conducted by interviewing ALJs and other staff, qualified independent contractors (which administer the second level of appeal), and CMS staff. In addition, the OIG analyzed CMS policies, procedures, documents and data on CMS participation in ALJ appeals.
The review found that when CMS participated in appeals, ALJ decisions were less likely to be favorable to appellants. In addition, the OIG raised concerns about the acceptance of new evidence and the organization of case files.
Related Products
-
Core Skills for Hospital Case Managers:
A guide to fundamental case management responsibilities, Core Skills for Hospital Case Managers serves as a training...
-
The RAC Toolkit for Hospitals and Health Systems
The RAC Toolkit for Hospitals and Health Systems: Manage Responses and Avoid Claims Under the Permanent Program is your...
-
The 2013 Medicare Compliance Forum: Las Vegas, NV
-
Level of Care Determinations for 2014: Las Vegas, NV
Attend the half-day seminar, Outpatient, Observation or Inpatient? Continuing to Walk the Tightrope of Regulatory Guidance...
-
OPPS and IPPS Reimbursement Fundamentals: Las Vegas, NV
Attend OPPS and IPPS Reimbursement Fundamentals, a half-day seminar on October 2nd in Las Vegas. Learn how CMS’ substantial...
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- Practice the six rights of medication administration
- Note similarities and differences between HCPCS, CPT® codes
- OB services: Coding inside and outside of the package
- Differentiate between types of wound debridement
- Code diagnoses and outpatient treatment for PTSD
- Q&A: Primary, principal, and secondary diagnoses
- What to include on the incident report
- ICD-10-CM coma, stroke codes require more specific documentation
- Know guidelines and subtle differences in code descriptions for laceration repairs
- E-mailed
-
- Stop emergency department violence against nurses, physicians
- Q&A: Resection or excision in ICD-10
- Inpatient-only procedures: Accuracy helps avoid denials, ensure compliance
- Can we charge for insertion of a PICC line when a certified nurse performs it?
- New workplace violence training program focuses on healthcare settings
- IV pushes that last more than 15 minutes
- Answer appropriate questions before billing for IV antibiotics and dressing change
- Improve meeting minutes with these seven tips
- How to get reimbursed for restorative nursing
- HIPAA Q&A: You've got questions. We've got answers!
- Searched
