Eli's Rehab Report

Published on Mon Jun 14, 2010 PDF

Keep your dollar amounts and deadlines close at hand.

With Medicare's Recovery Audit Contractors, and other fraud hunters, turned loose thanks to healthcare reform, gear up to submit more appeals. Just make sure you know the latest on amount-in-controversy requirements.

On May 7, CMS released Transmittal 1965, which spells out requirements for the claim amount in controversy for you to file a level-three (administrative law judge hearing) and level-five (federal district court) appeal.

Updates are affective Aug. 9, 2010, and include:

• 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 remain in controversy 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.

Don't miss: "CMS is adding information to the Amount in Controversy General Requirements, Principles for Determining Amount in Controversy and Aggregation of Claims..." the transmittal, CR 6894, reads. See below for a chart that spells out all amounts in controversy and the timeframes you're dealing with for each step in the appeals process.