Q:Our facility does not have a standard appeal letter template to respond to medical necessity denials. Do you have any suggestions for how to respond? Read More »
The improper payment rate for hospital outpatient services for the 2016 CERT report period was 5.4%, at a projected cost of $3.1 billion, which accounts for 7.5% of the overall Medicare fee-for-service improper payment rate.Read More »
Formerly known as Recovery Audit Contractors, the Tax Relief and Health Care Act of 2006 created Recovery Auditors to identify Medicare overpayments and underpayments made on claims of healthcare services provided to Medicare beneficiaries.Read More »
Before the first word of an appeal is ever written, review the denial chart thoroughly with the hospital’s appeal response ream. An appeal response team does not need to be big and certainly should not follow the usual constraints imposed...Read More »
Q:How does the Supplemental Medical Review Contractor (SMRC) determine which reviews to perform? Does SMRC work for CMS or our Medicare Administrative Contractor (MAC)? Read More »
According to an ACDIS poll, 71% of respondents conduct clinical validation reviews. Listen to the Quarterly Membership Call to learn more about this complex topic.Read More »
