Introduction

The Medicare and Medicaid appeals process is a system that allows beneficiaries and providers to challenge decisions made by Medicare or Medicaid regarding coverage, payments, or other issues related to healthcare services.  It involves several levels of appeal, including redetermination, reconsideration, Administrative Law Judge (ALJ) hearing, Medicare Appeals Council review, and judicial review.  The appeals process can be complex and may require legal representation, with strict deadlines for filing appeals.  It provides beneficiaries and providers with a possibility for recourse and resolution in case of disputes or disagreements with Medicare or Medicaid decisions.

Areas Covered In The Webinar

• Medicare and Medicaid Overview
• Appeals of Medicare Coverage and Payment Decisions
• Original Medicare Appeals
• Medicare Advantage Plan Appeals
• Medicare Prescription Drug Plan Appeals
• Medicaid Appeals

Why should you attend?

This seminar provides an overview of the differences between Medicare and Medicaid, and discusses the five levels of the Medicare appeals process for payment and coverage decisions for beneficiaries and enrollees under Original Medicare, Medicare Advantage (MA) Plans, and Medicare Prescription Drug Plans (PDPs).

Who Will Benefit

• Legal counsel and other professional advisors to healthcare providers.
• Healthcare providers and staff.
• Hospital and healthcare facility administration.
• Vendors and contractors who work in the healthcare sector.