Washington, DC (PRWEB) July 29, 2016
A new proposed rule would streamline the process for Medicare Advantage (MA) and Part D payment and coverage determination appeals, Atlantic Information Services, Inc.’s (AIS) Medicare Advantage News (MAN) reports in its July 21 issue. Using a tripartite approach, the Centers for Medicare & Medicaid Services (CMS) will address the current claims backlog and the rising number of appeals requests by increasing the number of available administrative law judges, taking administrative actions to reduce the number pending appeals and backlog, and proposing new legislation to reform the system.
Attorney Kelli Back tells MAN the “most engaging” part of the rule may be the proposal to make certain MAC decisions set precedent. “This has the potential to not only create some predictability at that level, but to allow [Recovery Audit Contractors] and Medicare Advantage plans to have some additional guidance to use in making determinations (and providers in billing for services) that could potentially cut down on the amount of appeals and overturns.”
Visit https://aishealth.com/archive/nman072116-05 to read the article in its entirety.
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Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for nearly 30 years. It develops highly targeted news, data and strategic information for managers in hospitals and health systems, health insurance companies, medical group practices, purchasers of health insurance, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, databases, websites, looseleafs, strategic reports, directories, webinars, virtual conferences and training programs. Learn more at http://AISHealth.com.