tci Medicare Compliance & Reimbursement - 2004 Issue 21

Appeals: CMS Requires Independent Carrier Hearing Officers

Changes help level the playing field.A formerly insignificant legal argument may soon become the centerpiece of providers' appeals of claims denials, thanks to yet another change in CMS' appeals policies.  As of this year, carriers can no longer collect overpayments until they prevail in the appeals process. Starting in October, the first level of appeals will be called "redeterminations," and the carriers will be sending you redetermination notices informing you of their decisions. Learning how to read these documents will be vital to your survival. According to the Centers for Medicare & Medicaid Services, these documents...

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