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Home Areas of InterestAdvocacyFederal Issues & ResourcesMedicare Denials, Audits, Appeals

Denials, Audits & Appeals
Appeals
Final Rule: Limitation on Recoupment of Overpayments (.pdf) - 10/1/09 Restricted
Comparison of Medicare Appeals Process: Part A, Part B, & Medicare Advantage (.pdf) - 3/10/09
Extended Repayment Plan Checklist (.pdf) - 12/10/08
Extended Repayment Plan Request Form (.pdf) - 12/10/08
Limitation on Recoupment (935) for Provider, Physicians and Suppliers Overpayments (.pdf) - 9/17/08
Amount in Controversy Requirement for ALJ & Federal District Court Appeals - 2/5/09
Modification to Model Medicare Redetermination Notice (.pdf) - 1/23/08
Reopening and Revision of Claim Determinations and Decisions (.pdf)
CMS Brochure on the Medicare Appeals Process (.pdf) - 8/7/06
New Appeals Forms for Administrative Law Judge Hearings - 7/01/05
Medicare Expedited Review Process for SNFs, HHAs and CORFs - 6/30/05
Summary of Changes to the Medicare Claims Appeals Procedures - 5/10/05
APTA Comments on Changes to Medicare Claims Appeal Procedures - 5/6/05
Comparison of Former and Current Appeals Process (.pdf) - 3/8/05
CMS Announces New Medicare Claims Appeals Process (.pdf) - 3/1/05

Audits
Medicare Clarifies Safeguards for Providers Facing Audits - 9/24/04

Recovery Audit Contractors
How to Prepare for the RACs (.pdf) - 7/8/09 Restricted
CMS RAC Review Phase-In Strategy (.pdf) - 6/29/09
RAC Educational Outreach Sessions (.pdf) - 6/2/09
RAC Contingency Fee Percentages - 11/4/08
RAC Medical Record Request Limits (.pdf) - 11/4/08
CMS RAC Resource Center (.pdf) - 10/8/08
Map of Future RAC Jurisdictions (.pdf) - 10/5/08
Map of RAC Expansion Schedule (.pdf) - 10/5/08
RAC Expansion Time Line (By Region) (.pdf) - 10/5/08 Restricted
RAC Expansion Timeline (By State) (.pdf) - 10/5/08 Restricted
Evaluation of the Three Year RAC Demonstration Program (.pdf) - 9/25/08
RACs to go Nationwide by 2010 (.pdf) - 2/13/09 Restricted
Summary of Demonstration Project for the Use of Recovery Audit Contractors - 11/21/05
Recovery Audit Contractors (RACs) Demonstration Project Medlearn Article (.pdf) - 11/18/05

 
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