Industry Notes:
With Medicare's Recovery Audit Contractors and other fraud hunters turned loose
Published on Tue May 18, 2010
With Medicare's Recovery Audit Contractors and other fraud hunters turned loose thanks to health care reform, gear up to submit more appeals. Just make sure you know the latest on amount-in-controversy requirements. CMS has spelled out requirements for the claim amount in controversy for you to file a levelthree (administrative law judge hearing) and levelfive (federal district court) appeal. New thresholds take effect Aug. 9, according to May 7 Transmittal No. 1965 (CR 6894). Starting then, at least $100 must remain in controversy to file an ALJ appeal, and for requests filed on or after Jan. 1, 2010, at least $130 must remain in controversy. At least $1,000 must be at stake to file a federal district court appeal, and for requests filed on or after Jan. 1, 2010, at least $1,260 must remain in controversy. The transmittal is online at
www.cms.gov/transmittals/downloads/R1965CP.pdf. A related MLN Matters article is at [...]