What Are.Medicare Appeals? / / Jessica Lee Gustafson and Abby Pendleton
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| Autore: |
Gustafson Jessica Lee
|
| Titolo: |
What Are.Medicare Appeals? / / Jessica Lee Gustafson and Abby Pendleton
|
| Pubblicazione: | Chicago, Illinois : , : ABA Publishing, , [2021] |
| ©2021 | |
| Edizione: | Second edition. |
| Descrizione fisica: | 1 online resource (66 pages) |
| Disciplina: | 780 |
| Soggetto topico: | Medicare - Law and legislation |
| Medicare - Claims administration | |
| Administrative remedies - United States | |
| Persona (resp. second.): | PendletonAbby |
| Nota di bibliografia: | Includes bibliographical references and index. |
| Nota di contenuto: | 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. |
| Titolo autorizzato: | What Are.Medicare Appeals |
| ISBN: | 1-64105-908-7 |
| Formato: | Materiale a stampa  |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione: | Inglese |
| Record Nr.: | 9910820654603321 |
| Lo trovi qui: | Univ. Federico II |
| Opac: | Controlla la disponibilità qui |