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CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 34.pdf

clm104c34.pdf
Preview of CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 34
🔗 Source: cms.gov
📊 Size: 109 KB
👤 Author: CMS
⬇️ Downloads: 494

Summary

Medicare Claims Processing Manual Chapter 34 discusses reopenings and revisions of claim determinations and decisions. A reopening is a remedial action to change a binding determination or decision resulting in an overpayment or underpayment. Reopenings are separate from the appeals process, discretionary, and not appealable. Contractors may conduct reopenings to revise initial determinations or redeterminations, but not for Medicare Secondary Payer recovery claims. Reopenings can be initiated by contractors, Qualified Independent Contractors, Administrative Law Judges, or the Appeals Council. Generally, reopenings are not conducted until appeal rights have been exhausted, but exceptions include cases where Medical Review requested documentation and clerical errors. A refusal to reopen is not an initial determination and is not appealable.

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Description

Medicare Claims Processing Manual Chapter 34 discusses reopenings and revisions of claim determinations and decisions.

Technical Information

  • File Format: PDF
  • File Size: 109 KB
  • Pages: 19
  • Language: EN
  • Author: CMS
  • Total Downloads: 494
  • Last Updated: 5 days ago

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This PDF document about CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 34 provides comprehensive information and guidance. Whether you're a beginner or advanced user, this resource offers valuable insights into CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 34.

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