Medicare introduces new appeals process.
This article addresses the wholly reformed appeals process in a broad based manner. It describes only the basic structure of a new appeals system. Appealing parties should be careful to learn in more detail the new system prior to pursuing an appeal. While many appeals can be pursued without legal counsel, it may be advisable to initially utilize an attorney for appeals until one becomes familiar and comfortable with the new process. Despite any of the shortcomings discussed above or new obstacles created by CMS in the rules, the appeals process should continue to be a very useful mechanism to successfully reverse inappropriate claim denials.
Dombi
William A
WA
National Association for Homecare & Hospice, USA. wad@nahc.org
D000368:Aged; D004608:Eligibility Determination / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006699:Home Care Services / Q000191:economics*; D017051:Hospice Care / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D012941:Social Responsibility; D014481:United States; D014483:United States Dept. of Health and Human Services