Administrative Appeals

CMS Revises Part B Billing Policy for Unnecessary Inpatient Admissions

by Thomas W. Coons, Carel Hedlund | Ober|Kaler on 3/29/2013

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

8th Circuit – Expressing Intent to Appeal in the Future Does Not Constitute an “Appeal.”

by Lane Powell PC - ERISA Law on 2/20/2013

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

U.S. Supreme Court Holds Equitable Tolling Doctrine Does Not Apply To Administrative Appeal Deadline

by Anastasia (Ana) K. Anderson, Renee M. Howard, David B. Robbins | Perkins Coie on 1/28/2013

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

Are Hernias Ratable?

by Virginia L. Hunt on 1/25/2013

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

Supreme Court Decides Kloeckner v. Solis

by James G. Ryan | Cullen and Dykman LLP on 1/25/2013

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

Eighteen Counties Will Send Out Revaluation Notices in 2013

by Chad Essick, Keith Johnson | Poyner Spruill LLP on 1/8/2013

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

Illinois Supreme Court to Consider If Mailbox Rule Applies to Administrative Appeal From Workers Comp Commission

by Kirk Jenkins | Sedgwick LLP on 1/5/2013

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

Supreme Court Clarifies Appeals Rights For Federal Employees

by Fisher & Phillips LLP on 12/29/2012

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

Be Careful How You Word Your Claims Procedure

by Angela Bohmann | Leonard, Street and Deinard - Employee... on 12/26/2012

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

Supreme Court Hears Argument in Sebelius v. Auburn Regional Medical

by King & Spalding on 12/14/2012

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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