Congress expects Medicare to provide quality medical care for its beneficiaries. However, Congress does not give Medicare enough money to meet this goal. When Medicare went into effect in 1966, there were 19 million people receiving Medicare benefits, and life expectancy for the average American was 70 years. By 2015, there were 55.5 million people receiving Medicare benefits, and life expectancy was 78.8 years. This puts Medicare providers in the middle of a quality care versus inadequate funding dispute, which can affect the kind of care a patient receives.
This book is about how to successfully fight for the payment of medically reasonable and necessary services when Medicare erroneously denies payment, or when Medicare erroneously demands a repayment of overpayment. The information in this book will help Medicare providers, Medicare billing companies, and health care attorneys who represent Medicare providers to prepare for Administrative Law Judge (ALJ) hearings—and will help you win those ALJ decisions.