For many years, CMS policy has been that, if an inpatient admission was denied for medical necessity reasons, the hospital could bill under Part B for only a limited set of services that, significantly, did not include...more
How does an ERISA claimant start an administrative appeal?
Can a mere request for medical records, and a reference to an “appeal in the future tense,” trigger the appeal? No....more
On January 22, 2013, the U.S. Supreme Court issued a unanimous decision in Sebelius v. Auburn Regional Medical Center, 568 U.S. _____ (2013), holding that hospitals cannot appeal Medicare inpatient reimbursement...more
Inguinal hernias are common work-related injuries for men, often caused by increased abdominal pressure during heavy lifting. According to the November/December 2012 AMA Guides Newsletter, men have a 27% lifetime risk of an...more
On December 10, 2012 the U.S. Supreme Court issued a unanimous decision in Kloeckner v. Solis holding that “[a] federal employee who claims that an agency action appealable to the MSPB violates an antidiscrimination statute...more
Counties in North Carolina are required to revalue real property every eight years; however, some counties chose to do so in shorter intervals. According to the North Carolina Department of Revenue, eighteen counties are set...more
Our preview of the civil cases to be heard by the Illinois Supreme Court during the upcoming January term concludes with Gruszeczka v. The Illinois Workers' Compensation Commission. Gruszeczka poses an important question:...more
On December 10, 2012, the Supreme Court handed down a critical victory to federal employees in a highly technical case. This decision now gives federal employees a simpler and less confusing process for appealing...more
In a recent decision of the United States District Court for the Eastern District of Oklahoma, a retiree who had begun work as a union employee and who during his employment was promoted to a salaried position, sued his...more
On December 4, 2012, the Supreme Court heard oral argument in Sebelius v. Auburn Regional Medical Center (Docket No. 11-1231), a case which presents the question whether the Medicare statute’s 180-day time limit for filing...more
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