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Departmental Appeals Board (DAB)SELECTED DECISIONS OF THE MEDICARE APPEALS COUNCILIn January 2003, the Medicare Appeals Council (MAC) initiated the posting of certain significant decisions and actions on the web site of the Departmental Appeals Board (of which it is a component). The following decisions and actions were selected for posting since they involve the adjudication of issues that may be of interest to various stakeholders in the Medicare appeals process. They are indexed by primary topic area. This compendium of MAC decisions will be supplemented periodically. Cases with an asterisk (*) were later appealed to the federal courts. The reader may wish to research any subsequent action by the courts. TOPIC AREA Requests for Escalation Advance Beneficiary Notification (ABN)/ Notice of Noncoverage Administrative Law Judge Hearings Amount in Controversy Blood Glucose Testing Dental Services Durable Medical Equipment (DME)/ Certificate of Medical Necessity (CMN) Durable Medical Equipment (DME)/National Coverage Determination (NCD) Equal Access to Justice Act (EAJA) Home Health Services "Incident To" Services/Waiver of Overpayment Recovery Medicare Advantage Program/Non-Participating Physician Charges Medicare Appeals Council Jurisdiction/Amount of Payment Medicare+Choice Program/Ambulance Services Medicare+Choice Program/Disenrollment Medicare+Choice Program/Drug Coverage Non-Physician Services Parenteral-Related Supplies/Carrier Jurisdiction Peer Review Organization (PRO) Review of Hospital Services Physician Billing and Payment/Assistant at Surgery Physician "Opt Out" of Medicare/Private Contracts With Beneficiaries Reopening/Outpatient Billing In the case of UMDNJ (March 14, 2005) Right to In-Person Hearing Services Outside the United States/Estoppel Skilled Nursing Facility - Prospective Payment System Statistical Sampling Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®. |
Last revised: September 10, 2008