The report shows that of 40,000 appeals in 2010, 56 percent of the time administrative law judges reversed claims denials in favor of appellants. When healthcare professionals filed, their rate of favorable decisions was 61 percent, compared to 28 percent when beneficiaries filed and 22 percent when state Medicaid agencies filed.
The OIG has recommended better training on Medicare policies to administrative law judges and clarification on unclear policies.
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