News: Pilot programs aim to reduce appeals’ backlog
CDI Strategies, July 17, 2014
Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!
Statistical sampling or alternative dispute resolution: These possible two solutions to the backlog of Medicare claim denial appeals are getting a trial run in the near future, according to a Report for Medicare Compliance article.
The AHA and three hospitals have an ongoing lawsuit regarding the appeals process, and Friday, July 11, they asked a federal court to grant an immediate favorable ruling to compel the Department of Health and Human Services to meet statutory deadlines for timely administrative review of Medicare claims denials.
It may take nearly 400 days to set a hearing and resolve an appeal, according to Nancy Griswold, chief ALJ from the Department of Health and Human Services’ Office of Medicare Hearing and Appeals (OMHA), the AHA’s News Nowreported. According to the AHA’s most recent RACTrac report, hospitals are appealing nearly 50% of their claims denials.
The statistical sampling option essentially allows facilitates with large numbers of claims to resolve them based on a statistically valid sample and extrapolation. The other option essentially sends the appeal to OMHA attorneys who mediate the case. (For more information, visit http://tinyurl.com/k7klm6z.)
Despite an abundance of audits, the Medicare fee-for-service improper payment rate rose in fiscal year 2013 to 10.1%, up from 8.5% in 2012, according to a July 9 report from the Senate Committee on Aging, AIS Health reported.
Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!
Related Products
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- The consequences of an incomplete medical record
- Practice the six rights of medication administration
- Complications from immobility by body system
- Nursing responsibilities for managing pain
- Q&A: Primary, principal, and secondary diagnoses
- OB services: Coding inside and outside of the package
- Prevent dehydration with nursing interventions
- Skills of effective case managers
- E-mailed
-
- Correctly bill ancillary bedside procedures in addition to the room rate
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding tip: Watch for different codes for SI joint injections
- Q/A: Coding infusions to correct low potassium levels
- Q&A: Utilization Review Committee Membership
- Q&A: Bill blood administration the same way for inpatient and outpatient accounts
- OB services: Coding inside and outside of the package
- Know the medical gas cylinder storage requirements
- Intravenous therapy guidelines
- ICD-10-CM coma, stroke codes require more specific documentation
- Searched