Report: Courts Favor Physicians in Coverage Denial Appeals Featured

Written by  Laura Dyrda | Tuesday, 04 December 2012 15:00
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A new report from the Office of the Inspector General shows that physicians fighting coverage denials have a good chance of succeeding, according to an American Medical News report.
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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