Sunday, August 25, 2019

Quality to the Next Level


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Appeals Council Referrals Library: Advanced Search

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This advanced search feature enables the user to search for Appeals Council Referrals and Decisions by ALJ appeal number, referral category, Medicare line of business (Part A, Part B, or DME), appellant, procedure code, and rationale. Users can also enter a range of dates for referrals or decisions, and search by Appeals Council disposition.

 

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NOTE:
This search feature will only allow for referrals and decisions dating from January 2013 onward.

  

Referral Categories

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This section contains examples of AdQIC referrals to the Medicare Appeals Council  for ALJ decisions prior to 2013. Click on the appropriate appeal category below to view a listing of the referrals. You can view the redacted referral document, and when available, a redacted version of the Appeals Council’s decision on the referral.

Ambulance Services

Ambulatory Surgical Center (ASC) Services

Appeals Procedures

Coding Issues

Comprehensive Outpatient Rehabilitation Facility (CORF) Services

Diagnostic Testing Services

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

Home Health Care Services

Noncovered Items and Services

Overpayment Issues

Physician Services

Skilled Nursing Facility Services

Waiver of Liability

  
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