Home Health & Hospice Week

Industry Notes:

With Medicare's Recovery Audit Contractors and other fraud hunters turned loose

With Medicare's Recovery Audit Contractors and other fraud hunters turned loose thanks to health care reform, gear up to submit more appeals. Just make sure you know the latest on amount-in-controversy requirements. CMS has spelled out requirements for the claim amount in controversy for you to file a levelthree (administrative law judge hearing) and levelfive (federal district court) appeal. New thresholds take effect Aug. 9, according to May 7 Transmittal No. 1965 (CR 6894). Starting then, at least $100 must remain in controversy to file an ALJ appeal, and for requests filed on or after Jan. 1, 2010, at least $130 must remain in controversy. At least $1,000 must be at stake to file a federal district court appeal, and for requests filed on or after Jan. 1, 2010, at least $1,260 must remain in controversy. The transmittal is online at www.cms.gov/transmittals/downloads/R1965CP.pdf. A related MLN Matters article is at [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Home Health & Hospice Week

View All