Be well-versed with Medicare appeals process
Be well-versed with Medicare appeals process
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Home Page > Health > Be well-versed with Medicare appeals process
Be well-versed with Medicare appeals process
Posted: Nov 30, 2009 |Comments: 0
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Some time back, Centers for Medicare and Medicaid Services (CMS) announced several changes to the appeals process in Transmittal 1762. As such, you need to update your appeals know-how. Here’s what you need to do:
• Focus on higher dollar amounts
CMS has changed the dollar amount in controversy to file certain levels of appeals. For level-three appeals (administrative law judge hearing) requests filed on or after January 1, 2009 must have at least $120 in controversy. Earlier the amount was $100. For level-five appeals (federal court review), requests filed on or after January 1, 2009 must have at least $1,220 in controversy. Earlier it was $1,180.
• Get to know the five-steps in Medicare appeals process
Be well-versed with these five steps: Re-determination, re-construction, Administrative Law Judge, Medicare Appeals Council, Federal Court.
• Increase your potential for successful appeals
It is highly important that healthcare providers and billers know the thresholds set by Medicare. If you know the rules, your chances for a successful appeal are much more. And now that Medicare can no longer correct minor errors or omissions on claims through the appeals process, you have to be geared up and submit clean appeals.
For more billing and coding know how, you can go for medical billing and coding conferences and stay up to date. These medical conferences will certainly help you get up-to-the minute industry updates, one-on-one access to a coding expert, and much more.
So what are you waiting for? Go for one, and pep up your billing and collections know how and be on mark as far as the reimbursements are concerned.
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Gain knowledge about medical conferences by attending proper Billing and collections conferences along with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.
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Gain knowledge about medical conferences by attending proper Billing and collections conferences along with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.
Categories: Centers for medicare and medicaid services Tags: Appeals, Medicare, Process, wellversed
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With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services
With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services
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Home Page > Business > Corporate > With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services
With Sumtotal, Pearson Government Solutions Supports U.s. Department of Health and Human Services
Posted: Sep 19, 2006 |Comments: 0
| Views: 307 |
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SumTotal® Systems, Inc. (Nasdaq: SUMT), the largest provider of talent, learning and business performance technologies and services, said today that Arlington, Va.-based Pearson Government Solutions has deployed SumTotal Enterprise Suite 7.1 software to manage training for 3,000 customer service representatives (CSRs) who staff the 1-800-MEDICARE Helpline. Pearson Government Solutions manages the nationwide telephone line on behalf of the Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) to help beneficiaries with their questions about Medicare and their Medicare health plans.
Specifically, Pearson uses SumTotal Enterprise Suite 7.1 to deliver online training to CSRs who field calls on topics such as Medicare’s prescription drug coverage plan. SumTotal’s software will also assess how well the CSRs have mastered instruction on a particular topic, as CSRs must meet a high level of proficiency on a weekly basis across a number of subject areas. With SumTotal’s talent-management software, Pearson can assess each CSR’s performance.
“Measuring our representatives’ performance is critical to success, but we also want to capture institutional knowledge and disseminate that quickly to our customer service representatives,” said Mike Bowers, senior vice president and general manager of Pearson Government Solutions’ Health division. “SumTotal’s TotalCollaboration product gives us an easy way to capture knowledge from our company experts, and transfer this knowledge for future reference.”
TotalCollaboration enables Pearson’s CSRs to get answers from company experts via threaded discussions and instant messaging. According to Bowers, the system from SumTotal will boost the 1-800-MEDICARE Helpline staff’s productivity and knowledge.
“Pearson has a reputation for delivering superior service to federal government agencies,” said Don Fowler, chief executive of SumTotal. “We’re pleased that they have chosen to work with SumTotal’s Government Solutions group to serve not only the U.S. Department of Health and Human Services, but also the American public.”
For more information about SumTotal’s products and services, visit www.sumtotalsystems.com.
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Categories: Centers for medicare and medicaid services Tags: Department, Government, Health, Human, Pearson, Services, solutions, Sumtotal, Supports, U.s.
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Home Page > Finance > Insurance > CIGNA Government Services Federal Medicare Contracts Awarded Prestigious Quality Management Certification
CIGNA Government Services Federal Medicare Contracts Awarded Prestigious Quality Management Certification
Posted: Dec 13, 2009 |Comments: 0
| Views: 200 |
CIGNA Government Services today announced it has again achieved the prestigious International Organization for Standardization (ISO) 9001:2008 certification, an internationally accepted quality management system. Certification includes all CGS Part B and Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Program Management functions under contract with The Centers for Medicare and Medicaid Services (CMS).
ISO 9001:2008 certification requires organizations to develop and adhere to stringent quality management standards and to have controls and mechanisms in place to comply with all regulatory requirements. The ISO 9001:2008 certification also requires processes that enhance customer satisfaction and ensure continual improvements. Companies are required to pass an exhaustive audit of all quality management processes prior to receiving certification.
“This award recognizes CIGNA’s dedication to continuous quality improvement. Achieving this level of certification underscores the commitment we’ve made to our customers to continually raise the bar on performance,” said Jean Rush, president of CIGNA Government Services. “We take very seriously our responsibility as a Medicare contractor and the positive impact we can have on the lives of millions of Medicare beneficiaries, providers of durable medical equipment and health care professionals. I am proud of our employees’ continued commitment to quality and performance excellence demonstrated by this certification.”
CIGNA Government Services has provided services to Medicare since 1991. In June 2007, CIGNA was awarded the largest of four DME MAC contracts to provide claims processing, customer service and administrative services to over 55,000 durable medical equipment, prosthetics, and orthotics suppliers in 15 states, including: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia as well as the territories of Puerto Rico and the U.S. Virgin Islands. CIGNA also holds federal Medicare Part B contracts for North Carolina and Idaho.
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Categories: Centers for medicare and medicaid services Tags: Awarded, Certification, Cigna, Contracts, Federal, Government, Management., Medicare, Prestigious, Quality, Services
Troubleshooting CROWNWeb
View this Lecture for FREE by signing up at www.prolibraries.com Viewany number of our other 28000 sessions from over 280 conferences by going to www.prolibraries.com Speaker(s) Matt McDonough Troubleshooting CROWNWeb – American Nephrology Nurses Association National Symposium 2009 The goal for ANNA’s 40th National Symposium is to provide a learning and networking environment that will assist nephrology professionals to enhance their practice as well as develop their mentoring and leadership skills.All invited faculty members and planning committee members participating in an ANNA-sponsored program are required to disclose any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of the educational activity. To review speaker disclosures, click here. The presence of any product, company, or corporation in any recording or content in no way signifies an endorsement of the product, company or corporation by ANCC Commission on Accreditation or the American Nephrology Nurses’ Association (ANNA). The Centers for Medicare and Medicaid Services implemented the CROWNWeb data system in late 2008. This session focused on concerns that have arisen since implementation and offer tools that can be utilized to assist nephrology health care professionals in the practice setting. 13da8a0d772a6bae587ba64685776859
Categories: Centers for medicare and medicaid services Tags: CROWNWeb, Troubleshooting
Secretary Sebelius: The Administration’s Agenda for Improving Quality and Value
Kathleen Sebelius, Secretary of the US Department of Health & Human Services Delivered at: National Summit on Health Care Quality and Value October 4, 2010 US Capitol Visitor Center Auditorium HealthCare.gov Take health care into your own hands. We accept comments in the spirit of our comment policy newmedia.hhs.gov US Department of Health & Human Services (HHS) www.hhs.gov
Categories: Centers for medicare and medicaid services Tags: Administration's, Agenda, Improving, Quality, Sebelius, Secretary, VALUE
Creating Healthy Work Environments
View this Lecture for FREE by signing up at www.prolibraries.com Viewany number of our other 32000 sessions from over 350 conferences by going to www.prolibraries.com Speaker(s) Dorrie Fontaine, PhD, RN, FAAN Creating Healthy Work Environments – American Nephrology Nurses Association Fall Meeting 2007 ANNA’s Fall Meeting for Nephrology Nurse Managers, Advanced Practice Nurses, and Clinicians offers you an opportunity to learn, experience, and recharge for a productive return to your practice. If your daily practice includes nurse management, advanced practice, or clinical practice, this program will provide valuable information and help you improve your skills! No matter what your clinical setting or area of expertise, the Fall Meeting has something for you. A hot topic on this year’s program agenda is the Conditions of Participation for Organ Transplant Centers recently released by the Centers for Medicare and Medicaid Services (see Sessions 215 and 225). Other sessions will address topics that you’ve requested – lab values, coagulopathies, fluid removal, home hemodialysis, wound care, depression in chronic illness, diagnostics in cardiovascular disease, fad diets and dietary supplements, continuous quality improvement, customer service, cultural diversity, healthy work environments, and much more!The presence of any product, company, or corporation in any recording or content in no way signifies an endorsement of the product, company or corporation by ANCC Commission on …
Categories: Centers for medicare and medicaid services Tags: Creating, Environments, Healthy, Work
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