News & Analysis as of

Administrative Appeals Healthcare

Arnall Golden Gregory LLP

Healthcare Providers Could Finally Have Their Day in Court: Supreme Court Holds That Defendants Are Entitled to Jury Trials When...

On June 27, 2024, the Supreme Court of the United States released its opinion in SEC v. Jarkesy, a case involving a Securities and Exchange Commission (“SEC”) enforcement action for civil penalties against an investment...more

King & Spalding

CMS Issues Final Rule Implementing Changes to Medicare Appeals Procedures

King & Spalding on

On May 3, 2019, CMS issued its final rule implementing changes to the appeal procedures for Medicare claims and Medicare prescription drug coverage determinations (the Final Rule). The Final Rule will be published in the...more

King & Spalding

CMS Updates Manual and Releases MLN Matters Article Regarding Appeals of Claims Decisions

King & Spalding on

CMS recently issued a Medicare Learning Network (MLN) Matters article in connection with Change Request 11042 released on April 12, 2019 (the Change Request), which revises the Medicare Claims Processing Manual (Publication...more

Tucker Arensberg, P.C.

CMS Limits Scope of Review for MACs

Tucker Arensberg, P.C. on

CMS issued a special edition MLN Matters meant to be effective August 1, 2015. The guidance reflects CMS instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the...more

King & Spalding

CMS Publishes Final Rule Establishing Appeal Process for Applicable Plans in Medicare Secondary Payer Cases

King & Spalding on

On February 27, 2015, CMS published a final rule, effective April 28, 2015, to establish a formal, multilevel administrative appeals process for applicable plans against which Medicare Secondary Payer (MSP) recovery demands...more

Foley & Lardner LLP

DME Suppliers, Get More Information on Your Medicare Appeals

Foley & Lardner LLP on

A new Office of Medicare Hearings and Appeals (OMHA) website offers intel on reimbursement appeal status, but does little to speed up the appeal process or eliminate the current backlog. It does, however, provide useful...more

Laner Muchin, Ltd.

Self-Insured Health Plans May Be Required To Allow Health Care Providers Access To Their Claims And Appeals Process

Laner Muchin, Ltd. on

In a precedent-setting case, a district court in the Northern District of Illinois recently ruled that in-network chiropractors were considered “beneficiaries” under the Employee Retirement Income Security Act of 1974 (ERISA)...more

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