The presence of a CMS Quality Improvement Organization (QIO) representative at an Administrative Law Judge (ALJ) hearing are now the norm. These QIO Reps are armed with a formal Position Paper opposing claim coverage. THIS introduces a level of clinical, regulatory, and legal scrutiny that can materially shift the outcome of an appeal. These Position Papers are typically constructed with precise references to the Medicare Benefit Policy Manual, Conditions of Participation,

Recent postings from Medicare Administrative Contractors (MAC) Palmetto GBA and CGS Administrators have shown that the top reasons for...

Joe Osentoski, BAS, RN-BC ADR and Appeals Specialist Gateway Home Health Coding & Consulting LLC Palmetto GBA (PGBA), the Jurisdiction M...

From the desk of Joe Osentoski, BAS, RN-BC ADR and Appeals Specialist Gateway Home Health Coding & Consulting LLC Medicare Administrative...