What Are.Medicare Appeals? / / Jessica Lee Gustafson and Abby Pendleton |
Autore | Gustafson Jessica Lee |
Edizione | [Second edition.] |
Pubbl/distr/stampa | Chicago, Illinois : , : ABA Publishing, , [2021] |
Descrizione fisica | 1 online resource (66 pages) |
Disciplina | 780 |
Soggetto topico |
Medicare - Law and legislation
Medicare - Claims administration Administrative remedies - United States |
ISBN | 1-64105-908-7 |
Formato | Materiale a stampa ![]() |
Livello bibliografico | Monografia |
Lingua di pubblicazione | eng |
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. |
Record Nr. | UNINA-9910788392603321 |
Gustafson Jessica Lee
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||
Chicago, Illinois : , : ABA Publishing, , [2021] | ||
![]() | ||
Lo trovi qui: Univ. Federico II | ||
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What Are.Medicare Appeals? / / Jessica Lee Gustafson and Abby Pendleton |
Autore | Gustafson Jessica Lee |
Edizione | [Second edition.] |
Pubbl/distr/stampa | Chicago, Illinois : , : ABA Publishing, , [2021] |
Descrizione fisica | 1 online resource (66 pages) |
Disciplina | 780 |
Soggetto topico |
Medicare - Law and legislation
Medicare - Claims administration Administrative remedies - United States |
ISBN | 1-64105-908-7 |
Formato | Materiale a stampa ![]() |
Livello bibliografico | Monografia |
Lingua di pubblicazione | eng |
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. |
Record Nr. | UNINA-9910820654603321 |
Gustafson Jessica Lee
![]() |
||
Chicago, Illinois : , : ABA Publishing, , [2021] | ||
![]() | ||
Lo trovi qui: Univ. Federico II | ||
|