tci Medicare Compliance & Reimbursement - 2015 Issue 11

Appeals: How OMHA's Medicare Appeals Process Could Soon Change Drastically

Be patient: Cutting your losses and taking 68% isn’t the answer, experts say. The Centers for Medicare & Medicaid Services (CMS) can’t keep up with the rising number of claims appeals, and now Congress and industry stakeholders are getting involved. There’s no question that big changes are needed to fix the huge backlog of appeals, but everybody seems to have a vastly different opinion on how to do it. Here’s what you need to know. On April 28, the U.S. Senate Finance Committee convened a hearing to discuss the Medicare claims appeals backlog. The...

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