New Toolkit Guides Hospices Through Medical Review and Appeals: From the ADR to the ALJ

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Hospices looking for a comprehensive overview of the Medicare medical review and claim appeals process now have a new tool(kit) to guide them: Reinhart's Medicare Hospice Appeals Toolkit: From the ADR to the ALJ.

This recently released Toolkit includes materials designed to manage the additional development request (ADR) process and to help hospices be well-informed and confident when challenging wrongly denied claims.

With this new toolkit, hospices can learn how to:

  • Effectively respond to record requests from the Intermediary/Medicare Administrative Contractor (MAC) or Recovery Audit Contractors (RAC)
  • Understand the types of probes hospices face and their consequences
  • Navigate the appeals process when a claim is denied

This Medicare Hospice Appeals Toolkit: From the ADR to the ALJ walks hospices through the ADR and Medicare appeals process. With each chapter, hospices learn the practical and strategic considerations associated with the ADR, targeted medical review and each level of the appeals process, with particular attention to the administrative law judge (ALJ) hearing. Based on years of guiding hospices through the medical review and claim appeals process, Reinhart has designed the toolkit to give hospices the information and confidence necessary to succeed on their own.

In addition, this toolkit provides:

  • Sample cover letters illustrating different options for presenting a case at the ADR, redetermination, reconsideration and ALJ levels
  • Fully customizable template letters for each level of response and detailed instructions on how to prepare an effective letter
  • A sample ADR and appeals spreadsheet for tracking deadlines and key information about claim denials
  • Sample checklists and a "to-do" list that outlines the tasks and decisions that need to be completed at each level of appeal

To allow for easy customization, the templates and checklists are provided on an accompanying CD-ROM.

How to Order

The Medicare Hospice Appeals Toolkit: From the ADR to the ALJ is available for purchase at the list price of $1095.

Reinhart's clients can purchase this toolkit at the reduced price of $650 by calling 608-229-2260 or by using the order form available on Reinhart's Web site.

The price for National Hospice and Palliative Care Organization (NHPCO) members who order through the NHPCO Marketplace is $695 plus shipping and handling.

About Reinhart's Toolkit Series

Reinhartʼs Hospice and Palliative Care Legal Service Group has been a recognized leader and counsel for hospices throughout the United States for more than 15 years. Our deep knowledge and appreciation of hospices, their missions, government regulations and their business needs has allowed us to serve as trusted advisors to many within the industry.

We developed the following toolkits to help hospices cost-effectively customize their approach to important areas of care and contracting:

Hospices can count on any of the attorneys in Reinhartʼs Hospice and Palliative Care Group to help with a broad array of issues facing hospices today. For more information about the Hospice and Palliative Care Legal Services Group, our toolkits or to subscribe to our complimentary Headlines in Hospice and Palliative Care E-Alerts, visit our Hospice Law Library.


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These materials provide general information which does not constitute legal or tax advice and should not be relied upon as such. Particular facts or future developments in the law may affect the topic(s) addressed within these materials. Always consult with a lawyer about your particular circumstances before acting on any information presented in these materials because it may not be applicable to you or your situation. Providing these materials to you does not create an attorney/client relationship. You should not provide confidential information to us until Reinhart agrees to represent you.