CMS Limits Scope Of Review On Certain Claims

Posted on Wednesday, August 26, 2015 3:04 PM

Until now, Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) have had discretion to develop new issues and review all aspects of coverage and payment related to a claim or line item, while conducting appeals. This expanded review of additional evidence can result in an unfavorable appeal decision reason different from the original. CMS has now issued new guidelines for redeterminations and reconsideration requests received by a MAC or QIC on or after August 1, 2015. Appellants will no longer be entitled to request a reopening of a previously issued redetermination or reconsideration. For any redeterminations and reconsiderations of claims denied following a post-payment review or audit, CMS has notified MACs and QICs to limit their review to the reason(s) the claim at issue was initially denied. Click here to read more.  

About Corridor

Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years. Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education . At Corridor, we make the business of caring for people Better! For the most important industry updates and news that impacts home health and hospice, please make sure to sign up for our weekly newsletter to receive the latest up-to-date industry information direct to your inbox!

For additional information, please contact Corridor at 1-866-263-3795.

Go Back

Explore Corridor’s Solutions

Share This Story, Choose Your Platform!