HealthCare Article: Medicare Appeals Process: It's New But Is It Improved?
2/15/2006
Written by Mintz Levin attorneys Karen S. Lovitch and Sarah A. Kaput and published in The RAP Sheet, a Publication of the American Health Lawyers Association Regulation, Accreditation, and Payment Practice Group, Winter (February) 2006, Volume 9, Issue 1.
As of January 1, 2006, the new regulations governing the process for appealing adverse actions related to Medicare fee-for-service claims will be fully implemented. These regulations are the product of an interim final rule (the Rule) published by the Centers for Medicare and Medicaid Services (CMS) on March 1, 2005.
Providers and suppliers must prepare for the possibility that the changes in the Medicare appeals process could have adverse effects given, among other things, the creation of a more prominent role for CMS in ALJ hearings and the revamped reopening process that could result in an increase in recovery of overpayments. At this point, CMS' claims of increased efficiency and fairness and improved results should be viewed with a healthy dose of skepticism.
Sarah is an associate in the firm's Washington office, practicing in the Health Section. Prior to joining Mintz Levin, Sarah was a Legal Department Extern at Saint Vincent's Catholic Medical Centers in New York City. She was also previously a summer associate at a Pennsylvania based law firm, researching, writing memoranda, and meeting with clients on issues regarding hospital licensure, federal tax exemption, Medicare payments, physician group practices, and other health law topics.
Karen is Of Counsel in Mintz Levin's Washington, D.C. office, practicing in the Health Section. Karen counsels health care clients on a variety of compliance, reimbursement, and operational issues. She provides advice regarding complex coverage, reimbursement, and pricing matters related to participation in the federal health care programs, including Medicare and Medicaid. In addition, Karen regularly advises clients on the legal, practical, and fraud and abuse implications of business arrangements.
