Medicare
Fourth-Level AppealMedicare Appeals Council ReviewIf any party to the Administrative Law Judge (ALJ) hearing is dissatisfied with the ALJ’s decision, the party may request a review by the Medicare Appeals Council.
Second-Level Appeal
Reconsideration By Qualified Independent Contractor
A party to a redetermination (level-one appeal) may request a reconsideration if dissatisfied with the redetermination.
First-Level Appeal
Redetermination by Medicare Contractors
A redetermination is an examination of a claim by Medicare contractor personnel who are different from the personnel who made the initial determination.
Since 1997, several key pieces of legislation have resulted in the creation and modification of the critical access hospital (CAH) program.
The AHA is working with CMS to provide hospitals with information on Medicare Part D, the new prescription drug coverage program. Enrollment begins Nov. 15, 2005, and coverage takes effect Jan. 1, 2006.
The Centers for Medicare & Medicaid Services \(CMS\) published in the May 4 Federal Register a proposed rule with changes to the fiscal year \(FY\) 2006 hospital inpatient prospective payment system \(PPS\). In addition to providing an inflationary payment increase for inpatient hospital…
AHA 2005 Annual Meeting Paper on Medicare
AHA 2005 Annual Meeting Paper Coordinating Care for the Chronically Ill
The Centers for Medicare & Medicaid Services \(CMS\) published in the Nov. 15 Federal Register the final rule for the Medicare hospital outpatient prospective payment system \(OPPS\) for calendar year 2005. The final rule includes statutory changes that resulted from the Medicare Modernization…