LEADER 03246nam 2200457 450 001 9910820654603321 005 20231021084639.0 010 $a1-64105-908-7 035 $a(MiAaPQ)EBC7293940 035 $a(Au-PeEL)EBL7293940 035 $a(EXLCZ)9928462341800041 100 $a20231021d2021 uy 0 101 0 $aeng 135 $aurcnu|||||||| 181 $ctxt$2rdacontent 182 $cc$2rdamedia 183 $acr$2rdacarrier 200 10$aWhat Are.Medicare Appeals? /$fJessica Lee Gustafson and Abby Pendleton 205 $aSecond edition. 210 1$aChicago, Illinois :$cABA Publishing,$d[2021] 210 4$dİ2021 215 $a1 online resource (66 pages) 311 08$aPrint version: Gustafson, Jessica Lee What Are... Medicare Appeals? Second Edition La Vergne : American Bar Association,c2022 9781641059077 320 $aIncludes bibliographical references and index. 327 $aIntro -- 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. 606 $aMedicare$xLaw and legislation 606 $aMedicare$xClaims administration 606 $aAdministrative remedies$zUnited States 615 0$aMedicare$xLaw and legislation. 615 0$aMedicare$xClaims administration. 615 0$aAdministrative remedies 676 $a780 700 $aGustafson$b Jessica Lee$01640248 702 $aPendleton$b Abby 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910820654603321 996 $aWhat Are.Medicare Appeals$93983702 997 $aUNINA