Medicare
Challenging Local Coverage DeterminationsChallenging Coverage DeterminationsSection 522 BIPA Challenge This process allows certain Medicare beneficiaries to challenge national coverage determinations(NCDs) and l
Legislation and Regulation Regarding Medicare AppealsMedicare, Medicaid, and SCHIP Benefits Improvement & Protection Act of 2000 (BIPA), Section 521In Section 521 of the Medicare, Medicaid and SCHIP Benefit
Third-Level Appeal
Hearing by an Administrative Law Judge
If at least $110 (2007 threshold) remains in controversy following the QIC’s decision, a party to the
Fourth-Level AppealMedicare Appeals Council ReviewIf any party to the Administrative Law Judge (ALJ) hearing is dissatisfied with the ALJ’s decision, the party may request a review by the Medicare Appeals Council.
Second-Level Appeal
Reconsideration By Qualified Independent Contractor
A party to a redetermination (level-one appeal) may request a reconsideration if dissatisfied with the redetermination.
First-Level Appeal
Redetermination by Medicare Contractors
A redetermination is an examination of a claim by Medicare contractor personnel who are different from the personnel who made the initial determination.
Since 1997, several key pieces of legislation have resulted in the creation and modification of the critical access hospital (CAH) program.
The AHA is working with CMS to provide hospitals with information on Medicare Part D, the new prescription drug coverage program. Enrollment begins Nov. 15, 2005, and coverage takes effect Jan. 1, 2006.
The Centers for Medicare & Medicaid Services \(CMS\) published in the May 4 Federal Register a proposed rule with changes to the fiscal year \(FY\) 2006 hospital inpatient prospective payment system \(PPS\). In addition to providing an inflationary payment increase for inpatient hospital…