Medicare Claims Appeals Process Handbook

by Perling, Lester J.

• ISBN13: 9780735564817
• ISBN10: 0735564817
• Edition: Looseleaf
• Format: Hardcover
• Copyright: 2008-06-02
• Publisher: Wolters Kluwer Law and Business

Summary

Anyone who submits Medicare claims and receives Medicare reimbursements needs to be fully prepared to follow the appeals process when claims are rejected and/or refunds are requested. Medicare Claims Appeals Process Handbook helps you understand - and explain - the process every step of the way. You'll know exactly what you can and can't do, The essential timeframes for pursuing appeals, where to send information, and how to proceed - at every level of the appeals process! The Medicare Claims Appeals Process Handbook will help you:Increase your likelihood of success in the claims appeal by lowering the possibility of procedural error and avoiding costly errors Navigate all four levels of the administrative appeal process Proceed to federal court if necessary Stay current with changing rules, regulations, and procedures Put best practices in place - immediately! Only Medicare Claims Appeals Process Handbook includes letters, forms, charts, and more - all designed to provide you with practical support throughout the process. Medicare Claims Appeals Process Handbook has been updated to include coverage of: The limitation on recoupment for Medicare provider and supplier overpayments and "Section 935 interest" Information on the Recovery Audit Contractor (RAC) demonstration program and implementation of the permanent program Statistics on the operation and efficiency of the new appeals process Data on the first three years of operation of the Office of Medicare Hearings and Appeals New information on amount in controversy requirements Sample of updated Medicare redetermination notice form Updated information and status of Medicare Administrative Contractor (MAC) implementation and jurisdiction Information on the transition of responsibility for Hospital Payment Monitoring Program functions from Quality Improvement Organizations to MACs Material on updated reopening regulations About the Author Mr. Lester J. Perling is a Partner in the Fort Lauderdale office of Broad and Cassel. He is a member of the Firm's Health Law and White Collar Civil and Criminal Fraud Defense Practice Groups. Mr. Perling is a board-certified health law attorney. He has had significant experience with Medicare and Medicaid reimbursement and fraud and abuse issues, privacy of health care information (HIPAA), federal and state administrative proceedings, provider operations issues, corporate compliance programs, and related matters for health care providers. He is a frequent national author and lecturer on various health law and health management topics. Mr. Perling was designated a 2006 and 2007 "Florida Super Lawyer" by Law & Politics magazine and was recognized in Chambers USA in Healthcare for 2006 and 2007. He was also recognized in 2008 by the top legal guide "The Best Lawyers in America," published by Woodward and White. Click here for Lester Perling's expertise in the Health Law industry and experience as a Partner with Broad and Cassel