BC Advantage - 2006 Issue 7

Medicare Appeals: Taking Claims to New Levels

For high-ticket items, appealing a Medicare decision can make a lot of sense, both for providers and beneficiaries, when you believe Medicare was not clear or incorrect about its coverage or other decision-making. Major changes have taken place in the Medicare appeals process stemming from the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA). Fifty-seven new pages of information have been added to the Medicare Claims Processing Manual. Two new contractors have come into play, the levels of appeal have been clearly delineated, amount in controversy requirements are in effect, and the parties to appeals...

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