Medicare Claims Appeals Process Handbook

Loose-leaf Binder: Approx. 710 pages
10" x 9.5"
ISBN 0735564817
978-0735564817
Aspen Publishers
Updated Annually!
(click below for the best currently available price for this important resource)

Medicare audits are a fact of life for health care providers that serve Medicare beneficiaries. Medicare processes over one billion medical claims every year, and in fiscal year alone, Medicare contractors denied over 150 million Medicare claims. For those who are charged with overseeing the reimbursement appeals process, the system can seem complex and confusing.

Anyone who submits Medicare claims and receives Medicare reimbursements needs to be fully prepared to follow the appeals process when claims are rejected and/or refunds are requested.

Medicare Claims Appeals Process Handbook helps you understand - and explain - the process every step of the way. You'll know exactly what you can and can't do, the essential timeframes for pursuing appeals, where to send information, and how to proceed - at every level of the appeals process!

Medicare Claims Appeals Process Handbook covers everything, including:

Recovery Audit Contractors
Evidence issues
National/Local Determination Process
And more!

The continuously updated loose-leaf binder helps you:

Increase your likelihood of success in the claims appeal by lowering the possibility of procedural error and avoiding costly errors
Navigate all four levels of the administrative appeal process
Proceed to federal court if necessary
Stay current with changing rules, regulations, and procedures
Put best practices in place - immediately!

This resource includes letters, forms, charts, and more - all designed to provide you with practical support throughout the process.

The author, Lester J. Perling, is a Partner in the Fort Lauderdale office of Broad and Cassel. He is a member of the Firm's Health Law and White Collar Civil and Criminal Fraud Defense Practice Groups. Mr. Perling is a board-certified health law attorney. He has had significant experience with Medicare and Medicaid reimbursement and fraud and abuse issues, privacy of health care information (HIPAA), federal and state administrative proceedings, provider operations issues, corporate compliance programs, and related matters for health care providers. He is a frequent national author and lecturer on various health law and health management topics.

Please note: These bestselling 3-ring binders are supplemented each year. Whenever you place your order, the publishers assure that you will be receiving the most current and thoroughly updated collection of guidelines, samples and forms. Thereafter, you will be able to receive additional annual supplements, if you wish, at an additional subscription cost, thereby ensuring that your procedures continue to be current and always in compliance for years to come.

Tabbed sections of your manual include:

Overview of Claims Processing System
The Role of National Coverage Determinations and Local Coverage Determinations
Overview of the New Claims Appeals Process
Provider Appeal Rights
Rules for Representation
Assignment of Appeal Rights
Initial Determinations and Redeterminations
Rules for Presenting Evidence
Qualified Independent Contractor Reconsiderations
Administrative Law Judge Appeals
Medicare Appeals Council Reviews
Judicial Review
Quality Improvement Organization's Reviews
Reopenings

Aspen Publishers, headquartered in New York City, is a leading information provider. We publish in the full range of formats, including updated manuals, books, periodicals, CDs, and online products. Our proprietary content is complemented by 2,500 legal databases, containing over 11 million documents. Our mission is to provide accurate, timely, and authoritative content in easily accessible formats, supported by unmatched customer care.

You may also be interested in / The Directory of Healthcare Recruiters /

Jump to a List / Health Administration & Leadership / Physician Executive, Medical Staff & Practice Management / Finance, Accounting, Economics, Billing & Reimbursement / Coding for Hospital, Physician & Clinical Services / Law, Malpractice, Ethics, Accreditation & Compliance / Quality Improvement, Outcomes & Customer Service / Risk Management, Security, Error Reduction & Patient Safety / Information Systems, Technology & Medical Records / Clinical Management & Executive Nursing / Behavioral Health, Social Work & Psychiatry Management / Human Resources, Management & Supervision / Directories, Data, Trends & Benchmarks / Software & CD-ROMs / Gift Ideas & Recommended Gifts / Journals, Magazines & Newsletters / Search for Books / Books Index /

Go to / Home Page / Toolbox for Health Administrators / Bookstore