OIG Report Finds LTC Medicare Part A Appeals Increase

The Department of Health and Human Services Office of Inspector General has found that the number of Medicare Part A appeals filed by skilled nursing facilities appeals has increased.  Traditionally, providers have 120 days to file a first-level appeal or determination after receiving a claim determination from a Medicare contractor; for instance, a provider might appeal a contractor’s determination it may have received as an overpayment. The number of redetermination processed by Medicare has increased 33% over four years from 2008-2012, even though success rates have decreased from 50% to 24% for first level appeals.  The report implies the growth of the recovery audit contractor program is contributing to these trends.

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