03246nam 2200457 450 991082065460332120231021084639.01-64105-908-7(MiAaPQ)EBC7293940(Au-PeEL)EBL7293940(EXLCZ)992846234180004120231021d2021 uy 0engurcnu||||||||txtrdacontentcrdamediacrrdacarrierWhat Are.Medicare Appeals? /Jessica Lee Gustafson and Abby PendletonSecond edition.Chicago, Illinois :ABA Publishing,[2021]©20211 online resource (66 pages)Print version: Gustafson, Jessica Lee What Are... Medicare Appeals? Second Edition La Vergne : American Bar Association,c2022 9781641059077 Includes bibliographical references and index.Intro -- Title Page -- Copyright Page -- Contents -- Introduction -- About the Authors -- Chapter 1 Medicare Part A and Part B Audits -- A. Comprehensive Error Rate Testing (CERT) Audits -- B. Medicare Administrator Contractor (MAC) Audits -- Targeted Probe and Educate -- Post-payment and Pre-payment Medical Reviews -- C. Supplemental Medical Review Contractor (SMRC) Audits -- D. Recovery Audits -- E. Unified Program Integrity Contractor (UPIC) Audits -- Chapter 2 Overview of the Medicare Part A and Part B Appeals Process -- A. Stage 1: Redetermination -- Recoupment during Redetermination -- B. Stage 2: Reconsideration -- Recoupment during Reconsideration -- C. Stage 3: ALJ Hearing -- ALJ Backlog and Resolution -- Statistical Sampling Initiative -- Settlement Conference Facilitation Pilot -- D. Stage 4: Medicare Appeals Council (the "Council") Review -- E. Stage 5: Federal District Court Review -- Chapter 3 Legal Challenges to Part A and Part B Audit Determinations -- A. Advocating the Merits -- B. Treating Physician Rule -- HCFA Ruling 93-1 -- C. Waiver of Liability -- D. Provider without Fault -- E. Challenges to Statistical Extrapolations -- Medicare Prescription Drug, Improvement and Modernization Act -- Challenges to the Validity of a Statistical Sample -- Resources and Reference Materials -- A. ABA Health Law Section Resources -- B. Government Resources -- C. Statutory, Regulatory (i.e., Code of Federal Regulations ("[CFR]")), and Sub-Regulatory Guidance Citations Related to the Medicare Part A and Part B FFS Appeals Process and Medicare Audits -- D. Statutory, Regulatory, and Sub-Regulatory Guidance Citations Related to the Medicare Part A and Part B FFS Related to Legal Challenges to Medicare Audit Determinations -- Index.MedicareLaw and legislationMedicareClaims administrationAdministrative remediesUnited StatesMedicareLaw and legislation.MedicareClaims administration.Administrative remedies780Gustafson Jessica Lee1640248Pendleton AbbyMiAaPQMiAaPQMiAaPQBOOK9910820654603321What Are.Medicare Appeals3983702UNINA