CMS Reveals One Surprise at the OMHA Appellant Forum

Some Appeals Receive Some Protection

The OMHA Medicare Appellant Forum Home Page at hhs.gov

The OMHA Medicare Appellant Forum Home Page at hhs.gov

Post-payment denials for anything other than “lack of documentation” are protected from reviews for additional or new reasons for denial, effective August 1, according to Michael Crochunis, Deputy Director for the Medicare Enrollment and Appeals Group at the Centers for Medicare & Medicaid Services (CMS). Crochunis revealed the new policy while speaking at the OMHA Medicare Appellant Forum on Thursday, June 25. The policy change is the result of CMS’ conversations with the provider community at and since the last Appellant Forum, held in October, 2014.

“MACs and QICs will still be permitted to deny claims for new reasons if the claims were initially denied on a prepayment basis,” he further explained. Crochunis also indicated that one exception to this policy will be claims denied for lack of documentation. “In these cases,” he said, “the contractors will still evaluate whether the items or services meet all applicable coverage and payment requirements.”

Watch this short 2-minute clip below to hear his entire statement about the new policy.

Complete Recording

In case you missed the forum or simply wish to review a part or all of it, a full recording is available, below. The first five minutes are missing, but this was only the introductions, and we are able to pickup with the very first speaker. The complete recording is 2 hours 21 minutes long.

Downloads

All the powerpoint presentations are available at this link.

The original page at OMHA is here.

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