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
-
- CMS seeks comment on quality measures
- Practice the six rights of medication administration
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Nursing responsibilities for managing pain
- CMS creates web portal for questions about 1135 waivers, PHE
- Q&A: Primary, principal, and secondary diagnoses
- OB services: Coding inside and outside of the package
- ICD-10-CM coma, stroke codes require more specific documentation
- The consequences of an incomplete medical record
- E-mailed
-
- Coronavirus vaccination: 4 best practices for communicating with patients
- Q&A: Pressure ulcer POA code confusion resolved
- Neurological checks for head injuries
- Keyes Q&A: Generator lighting, fire dampers, eyewash stations, ISLM fire drills
- Including 46600 in E/M leveling systems
- How to get reimbursed for restorative nursing
- Fetal non-stress tests represent important part of maternal and fetal health
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding tip: Know how to correctly code each procedure an otolaryngologist can perform on turbinates
- Coding Clinic reiterates guidelines for provider documentation
- Searched