We use cookies to enable digital experiences. Disable them/read. Browse on or click to
Lexis Nexis What Are . . . Medicare Appeals?
A complete overview of the Medicare FFS audit and Medicare appeals environment.
Publisher:
American Bar Association
Select a format
International Order Inquiry
Select subscription type
Estimated annual upkeep cost:
/
Estimated number of annual updates:
Terms & conditions
Subscribers receive the product(s) listed on the Order Form and any Updates made available during the annual subscription period. Shipping and handling fees are not included in the annual price.
Subscribers are advised of the number of Updates that were made to the particular publication the prior year. The number of Updates may vary due to developments in the law and other publishing issues, but subscribers may use this as a rough estimate of future shipments. Subscribers may call Customer Support at 800-833-9844 for additional information.
Subscribers may cancel this subscription by: calling Customer Support at 800-833-9844; emailing customer.support@lexisnexis.com; or returning the invoice marked "CANCEL".
If subscribers cancel within 30 days after the product is ordered or received and return the product at their expense, then they will receive a full credit of the price for the annual subscription.
If subscribers cancel between 31 and 60 days after the invoice date and return the product at their expense, then they will receive a 5/6th credit of the price for the annual subscription. No credit will be given for cancellations more than 60 days after the invoice date. To receive any credit, subscriber must return all product(s) shipped during the year at their expense within the applicable cancellation period listed above.
The total price includes the product(s) listed in the Order Form and any Updates for a limited period (minimum period of 30 days) after the order is placed ("Order Window"). Shipping and handling fees are not included in the grand total price.
All shipments may be returned, at subscribers' expense, for full credit of the Price within 30 days of receipt.
Shipments may not be returned, and no credits will be issued, more than 30 days after receipt.
After the Order Window, subscribers will receive notice of Updates along with the then-current grand total price and order process as Updates become available. Subscribers will only be shipped those Updates they specifically request.
Product description
View a sample of this title using the ReadNow feature
With more than 60 million beneficiaries, the Centers for Medicare & Medicaid Services (CMS) processes more than 1 billion Medicare Part A and Part B Fee-for-Service (FFS) claims each year. The vast majority of these claims are processed without undergoing claims review, creating vulnerability for the Medicare Trust Funds. Authorized by various legislative actions, CMS has contracted with claims review entities to perform post-payment and pre-payment claims review. Health care providers and suppliers that have received a Medicare FFS claim denial or overpayment determination may appeal the initial determination through a five-stage uniform Part A and Part B appeals process.
This book provides an overview of the Medicare FFS audit and Medicare appeals environment. It starts with an overview of the various CMS contractors performing claims review (including post-payment and pre-payment auditing activities). Then the Medicare Part A and Part B appeals process is examined. Finally, appeal strategies are set forth along with legal challenges applicable to Part A and Part B unfavorable claims determinations, with which attorneys should familiarize themselves when representing a health care entity subject to audit. A list of resources and references is included at the conclusion of this book.
eBooks, CDs, downloadable content, and software purchases are noncancelable, nonrefundable and nonreturnable. Click here for more information about LexisNexis eBooks. The eBook versions of this title may feature links to Lexis+® for further legal research options. A valid subscription to Lexis+® is required to access this content.
