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CMS limits of scope of MAC/QIO review for appeals
“Scope Creep” in Appeals is Dead CMS has instructed MACs and QICs to limit their review to the reason(s) the claim or line item at issue was initially denied. For redeterminations and reconsiderations of claims denied following a complex prepayment review, a complex post-payment review, or an automated post-payment review by a contractor, Limiting the scope of review on redeterminations and reconsiderations of certain claims. MLN Matters Number SE1521.
NEWS POLL Friday February 17 2017
Nominee Tom Price Wants Shift Away from Medical Necessity Audits To Anti-Fraud Audits
CMS should focus its billing audits less on verifying medical necessity and more on rooting out blatant fraud, the agency’s likely next secretary said Tuesday. Rep. Tom Price, R-Ga.
CMS Updates Hospital Appeals Settlement
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