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CodeMap Compliance Briefing: 5/23/03: Revised Medicare Appeals Provisions

Editor's Welcome: As promised, this week we conclude our discussion of the Medicare appeals process and recently enacted changes. To refresh your memory you may want to consult last week's briefing concerning Carrier Reviews. This week we will examine the Fair Hearing and the Administrative Law Judge Hearing. Remember, consistent use of the appeals process results in improved collections, faster resolution of billing questions, and provides valuable documentation showing that you are serious about Medicare compliance.

Also, the appeals process is an effective way to call attention to erroneous or misinterpreted carrier or fiscal intermedicary policy. If everyone assumes someone else will take up the battle, payers remain unaware of the problems and turn questionable actions into established policy that is difficult to change.

Sincerely,

Charles B. Root, Ph.D.

The Fair Hearing

If the result of the Carrier Review is unsatisfactory, and the amount in question is a....

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