A Practical Guide to Medicare Appeals describes the steps necessary to successfully resolve appeals of all types of Medicare determinations. Co-authored by a CMS hearing officer and a private practitioner with years of Medicare appeals experience, this book will walk practitioners through every step of the very confusing and sometimes self-contradictory rules so that appeals can be decided on their merits rather than barred for procedural rules violations.
"This book is about how to successfully fight for the payment of medically reasonable and necessary services when Medicare erroneously denies payment, or when Medicare erroneously demands a repayment of overpayment"--
In the last four years, the Chief Judge's office at the Office of Medicare Hearings and Appeals has squandered millions of our tax dollars hiring HQ staff instead of worker bees. It affects all of us, not just those enrolled in Medicare. Hurry Up and Wait relies on the perspective its author gained presiding over more than 3,500 Medicare hearings as an administrative law judge. It gives an overview of Medicare, explains the appeal process, shows how mismanagement at OCALJ and poor work by CMS contractors created a 600,000 case backlog, analyzes proposals to fix the problem, provides real solutions, and shows you how to make your voice heard to make much needed changes in the system. A portion of the proceeds are donated to worthy causes, such as the Center for Medicare Advocacy, and Save Lakewood Hospital. Note: You can buy a book without setting up a Lulu account. Thank you.
An appeal is the action you take if you disagree with a coverage or payment decision made by Medicare, your Medicare Advantage Plan (like an HMO or PPO), other Medicare health plan, or your Medicare Prescription Drug Plan. You have the right to appeal if Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan denies one of these: A request for a health care service, supply, item, or prescription drug that you think you should be able to get; A request for payment of a health care service, supply, item, or prescription drug you already got; A request to change the amount you must pay for a health care service, supply, item, or prescription drug. You can also appeal if Medicare or your plan stops providing or paying for all or part of a health care service, supply, item, or prescription drug you think you still need. This publication has important information about: How to file an appeal if you have Original Medicare; How to file an appeal if you have a Medicare Advantage Plan or other Medicare health plan; How to file an appeal if you have Medicare prescription drug coverage; Where to get help with your questions. Also available in Spanish.
