In the event a Medicare claim is denied, the Department of Health and Human Services provides applicants with a five-level appeals process, including redetermination, reconsideration, hearing before an administrative law judge, review by the Medicare Appeals Council and, lastly, judicial review in a federal district court.
In our last post, we began exploring how the Centers for Medicare and Medicaid Services recently unveiled a proposal for a new Medicare physician payment model as part of a mandate included in legislation passed by Congress last year to overhaul the system.
The current Medicare physician payment system is set up in such a way that participants are paid based more on the quantity of care provided as opposed to the quality. In other words, they receive payments based on the number of treatments, tests and procedures they perform, as opposed to the amount of time they spend developing treatment plans or discussing issues with patients.
Today, we'll conclude our discussion of Medicare overpayments by taking a closer look at one of the more effective options available to those medical professionals blindsided by a demand letter from the Medicare Administrative Contractor: requesting an appeal.
In a series of ongoing posts, we've spent some time examining the process that unfolds when the Centers for Medicare and Medicaid Services discovers that a Medicare overpayment has been made to a medical professional.
In our last post, we discussed how even the most diligent medical providers can sometimes make regulatory or administrative mistakes despite their best efforts, and how these mistakes can sometimes turn into decidedly difficult legal matters.
There is no question that medical providers have far too much on their plate as far as both regulatory and administrative matters are concerned. Indeed, the unfortunate reality is that no matter how hard individuals and organizations attempt to keep abreast of all changes or remain compliant with all regulations, mistakes can still occur.
Last time, we started discussing how medical providers must do everything in their power to ensure that they do not run afoul of federal health laws from the Stark Law and HIPAA to Medicare and Medicaid.
As we touched on in our previous post, it's imperative for medical providers to take the necessary steps to ensure that they remain compliant with all applicable state and federal health laws. While this naturally includes things like the Stark Law and HIPAA, it also includes both the Medicare and Medicaid programs.
As the calendar turns from February to March, you may not be feeling the pressure of the looming federal income tax deadline now, but procrastination only breeds fear and desperation. And this could lead to questionable choices as the deadline comes.