Administrative Appeals: Strategies for Success in UPIC, ALJ and MAC Appeals is proudly presented to you by National Association for Home Care & Hospice. Thank you. We hope that you enjoy your course.
Description:
This session will provide an overview of the CMS Administrative Appeal process for home health and hospice providers. This session will discuss: (i) Redetermination Appeals by a Medicare Administrative Contractor, (ii) Reconsideration Appeals before a Qualified Independent Contractor, (iii) ALJ Appeals before the Office of Medicare Hearings and Appeals, and (iv) Appeals to the Medicare Appeals Council. This session will also provide an overview of audit activity and initiatives by UPICs and other governmental investigative bodies. This session will further provide an overview of best practices to responding to governmental and private payor audits and with navigating through the multi-tiered Medicare appeal process.
Learning Objective 1:
Explain the CMS Administrative Appeal process, including the four phases of the Medicare appeal process.
Learning Objective 2:
Identify audit activity and initiatives by UPICs, MACs, and other governmental entities with respect to home health and hospice providers.
Learning Objective 3:
List best practices with respect to responding to governmental and non-governmental payor audits and with respect to handling the various phases of the Medicare appeals process.
Faculty:
Nursing 1.0 Contact Hours awarded.
Nursing Contact Hours for this module will expire on October 15, 2025.