CMS Will Limit Scope of Review on Appeals of Certain Post-Payment Denials

September 14, 2015 – In The News
Medical Practice Compliance Alert

William H. Maruca was featured in the Medical Practice Compliance Alert article, “CMS Will Limit Scope of Review on Appeals of Certain Post-Payment Denials.” Full text can be found in the September 14, 2015, issue, but a synopsis is below.

CMS has instructed Medicare administrative contractors (MACs) and qualified independent contractors (QICs) to limit redeterminations and reconsiderations of post-payment denials to the reason that claims or line items are initially denied, putting an end to a frustrating source of denials.

“If the provider can refute the stated basis for the denial, the audit contractor can’t go back and bring up another basis for denial,” said Bill Maruca.