• CMS Proposed Rule and Administrator Ruling Affecting RAC Appeals
  • March 21, 2013 | Authors: Cecile L. Gordon; Jeffrey S. Moore; Eugenia S. Thomas
  • Law Firms: Phelps Dunbar LLP - Jackson Office ; Phelps Dunbar LLP - New Orleans Office ; Phelps Dunbar LLP - Tupelo Office ; Phelps Dunbar LLP - Jackson Office
  • On March 13, 2013, CMS released a proposed rule (CMS-1455-P) to revise Medicare Part B billing policies when a Part A claim for an inpatient admission is denied for lack of medical necessity. CMS will be accepting comments until May 17, 2013 on this rule.

    Also on March 13, CMS released an Administrator's Ruling (CMS-1455-R) to address pending Part A appeals denied by the RAC due to lack of medical necessity. This ruling establishes a process for handling these pending appeals until the proposed rule (noted above) can go through notice and comment rulemaking procedures.

    Both the proposed rule and the Administrator's Ruling are scheduled to be published in the Federal Register on March 18, 2013.