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Home Health & Hospice Week

Appeals:

Don't Ignore Grijalva Appeals If You Don't Do Managed Care

Published on Thu Jan 29, 2004

Fast-track appeals to hit Medicare fee-for-service too.

Home health agencies that do little or no managed care business may be tempted to ignore the Grijalva regulations, but that could be a very bad idea. Similar fast-track appeal requirements for regular Medicare beneficiaries are in the works, the Centers for Medicare & Medicaid Services said in its Jan. 22 Open Door Forum on the new requirements. The Benefits Improvement and Protection Act of 2000 required the appeals changes, but CMS hasn't yet put them in place. Beneficiary advocates "would love for agencies to be required to continue to provide services while they are waiting for a response to a demand claim" for regular Medicare, notes Burtonsville, MD-based attorney Elizabeth Hogue. "These regulations certainly lead regulators in this direction." Hogue warns.
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