Watch High-Risk Claims as First-Level Appeal Success Drops

November 4, 2013 – In The News
Part B News

William Maruca was quoted in the Part B News article "Watch High-Risk Claims as First-Level Appeal Success Drops." While the full text can be found in the November 4, 2013, issue of Part B News, a synopsis is noted below.

Recent reports show that Part B claims, especially in the high-denial categories of DME and labs, are being appealed at a higher rate. These first-level appeals are becoming increasingly unsuccessful, leaving some attorneys to say you must focus your attention on high-denial claims categories in response.

It would be a good idea to take extra care of claims that are among the most-denied types, attorneys say, as those claims saw the largest increase in appeals.

DME claims have long been an OIG target, says William Maruca. “It’s always been in the crosshairs as a major focus of ‘real,’ i.e. criminal, fraud.”