Medicare Judges Overturn Most Claims Denials, Report Finds

Law360, New York (November 15, 2012, 5:48 PM EST) -- The administrative law judges who hear appeals of Medicare claims decisions side with appellants most of the time, and in the case of hospital claims fully overturn the original decisions 72 percent of the time, according to an inspector general report released Thursday.

Under the appeals process, administrative law judges, or ALJs, hear the third level of appeals. First, the appellant — almost always a provider who was denied a claim — asks for review from the contractor who made the denial. The appellant can then...
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