Craneware created a “scorecard” for hospitals to use in an attempt to quantify the value of CMS’ Global Settlement for appeals of RAC denials. CMS set the deadline for hospitals to decide and file to accept the settlement offer by … Continue reading →
“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.