The Five Levels of the Medicare Appeals Request Process

This detailed look at each level of Medicare appeals gives complete information on time periods as well as contact information.

• Talk about Medicare appeals on the message board 
• Ask our expert a question about Medicare appeals 

Medicare Implications of the American Recovery And Reinvestment Act of 2009

The ARRA passed in February included several details that ultimately affect Medicare. Take a look at how the legislation changes Medicare.

• President exempts Medicare physician payments from proposed PayGo rules 
• Talk about ARRA on the message board 
• Ask our expert a question about ARRA 

Paying for Medical Education—GME and IME Counts and Documentation Issues

Medicare reimbursement for education has become a complex reporting and documentation process. These strategy suggestions may lessen the complexity.

• Talk about medicare education documentation on the message board 
• Ask our expert a question on education documentation 

Cost Report Appeal Process Issues

When the Centers for Medicare and Medicaid Services (CMS) unveiled a long-awaited revamped rule for the cost report appeal process last May, it changed the way the appeals are handled dramatically—at least as they relate to provider’s responsibilities. In addition, regulations that had been on the backs for years, and not vigorously enforced, will now be receiving a closer look by the PRRB.

• PRRB Issues New Rules on Appeal Procedures 
• CMS Adopts Changes to PRRB Appeal Procedures 
• Talk about cost report appeal on the message board 

Medicare Disproportionate Share: Identifying Medicaid Eligible Days and Surviving an Audit   

The Medicare Disproportionate Share Hospital (DSH) adjustment provision has been in effect since 1986. The payment adjustment was designed to compensate hospitals that care for a greater proportion of low-income patients. Are you calculating yours correctly?

• Federal Court Denies Request for Medicare Payment Data 
• Methods to Qualify for the Medicare Disproportionate Share Hospital (DSH) Adjustment  
• Talk about disproportionate share on the message board 

New Medicare Payment Appeal Process Takes Effect  

The Centers for Medicare and Medicaid Services (CMS) recently implemented a new Final Rule that will substantially revise the process used to contest a disputed decision from a Fiscal Intermediary (FI) on a case involving Medicare payments before the PRRB--the Administrative tribunal appointed by Congress to adjudicate disputes.

• New Medicare Payment Appeals Process Frequently Asked Questions (FAQs) 
• Preparing for a Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC) 
• Important MAC Implementation Dates 
• Talk about the new medicare appeals process on the message board 

Medicare Bad Debt Audits—Negotiating Re-Charted Waters  

In practice, the JSM did little to clarify matters and provide objective guidance on the issue; instead it created confusion and controversy and spawned several lawsuits that have muddied the waters even further.

• Bad Debts for Outpatient Services Paid on a Fee Schedule 
• Bad Economy making Bad Debt Collection Worse 
• Talk about bad debt collection on the message board 

HCAHPS—In Search of Quality and Full Medicare Payments  

Quality Assurance leaders like the National Quality Forum (NQF), a coalition that represents the consensus of many healthcare providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality organizations, maintain that health care outcomes are tied directly to patient perceptions of the care they receive.

• Timeline of HCAHPS Development
• Press Ganey’s 2008 Hospital Pulse Report 
• Talk about HCAHPS on the message board 

New Rules to Increase Hospital Work on Front End of Reporting Process  

The PRRB is an Administrative tribunal appointed by Congress to adjudicate disputes related to provider Medicare issues--an independent panel to which a certified Medicare service provider may appeal if it is dissatisfied with a final determination of its fiscal intermediary or the Centers for Medicaid & Medicare Services (CMS). A decision of the Board may be affirmed, modified, reversed or vacated and remanded by the CMS Administrator.

• CMS Implements Restrictive Rules for Medicare Part A 
• Final Rule Clarifications and Revisions 
• Talk about Occupational Mix on the message board 

The Hospital Occupational Mix—the Robin Hood Factor Gone Wrong

Hospital Occupational Mix has not always worked as it was intended. Read about the current state of occupational mix and how it might affect your hospital system.

• 2007-2008 Update to the Medicare Wage Index Occupational Mix Survey 
• Talk about Occupational Mix on the message board 

Keys to Reporting Uncompensated Care

The reporting of charity care and bad debt has come under increased scrutiny recently. Read the keys to reporting uncompensated care.

• Eligibility Criteria for Charity Care 
• Checklist of Items to Be Considered in a Charity Care Policy
• Calculating Uncompensated Care 

Ask the Experts

Feel free to ask a question of our resident Medicare Payment experts.  This new feature to the forums will display all asked and answered questions.

View the Expert Roster  | Pose a question  | See all questions

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