tci Medicare Compliance & Reimbursement - 2013 Issue 21

Appeals: Expect A Positive Outcome When Appealing A Denial

More than half of redeterminations favor Part B practices. A recent audit report from the OfficeoftheInspectorGeneral (OIG) indicates that Part B practices stand a good chance of winning an appeal when they’ve received a denial from their MAC or a request for a refund from a RAC auditor. The chances of your coming out on top are high as appeals till last year were often decided in favor of the practice. Out of 2.1 million redeterminations decided in 2012, 51 percent were either fully or partially favorable to the Part B practices who filed them, according to...

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