This first-of-its-kind GHA Appeals Handbook was developed to give hospitals, health care providers, consultants and legal counsel a practical guide to navigate and respond to Medicare or Medicaid audits by CMS or its subcontractors (MACs, MICs, ZPICs, CERTs and others) or by the state through the Georgia Department of Community Health (DCH). The handbook was written by a group of legal and clinical experts and their staff. It is a must-have for any individual involved with or overseeing Medicare and Medicaid appeals.
Overview
With the onset of the RACs, MACs, MICs and other federal and state contractors, hospitals and other health care providers need a tool that can help them understand what to do with a denial of coverage and how to appeal such a denial. In 2008, while GHA developed the Recovery Audit Contractor (RAC) Readiness Manual for Georgia hospitals, there was still a need to further understand how to conduct a federal or state appeal of a denial of coverage and how to incorporate clinical criteria such as InterQual and Milliman into the appeal process. This handbook will help clinicians and non-clinicians alike understand how to organize and use the clinical facts into a clear and convincing appeal assessment and argument to the appropriate federal or state organizations. It will provide the users with detailed timelines and practical tips in navigating the appeal process.
Who Should Have This Manual?
CEOs, CFOs, Legal Counsel, Compliance Officers, RAC and MIC Teams, Patient Financial Services, Health Information Management (HIM) staff, Nurse Managers, Medical Directors and Physicians, and Health Care Consultants.
Pricing & Ordering Process
The GHA Appeals Handbook is $100.00 for GHA Members and $200.00 for non-members. An order form is available by clicking here. Payment must be received with each order. Checks should be made payable to the Georgia Hospital Association or credit card information may be provided on the order form.
Questions?
For more information, contact Liz Schoen, Associate General Counsel and Vice President, Compliance Services, at 770-249-4564 or Susan Simmone, Legal Services Assistant, at 770-249-4529.
CLICK HERE TO RESERVE YOUR COPY
|
