Art of Healing Medicine, P.C. v. Burwell

MEMORANDUM & ORDER

JACK B. WEINSTEIN, Senior District Judge.

Table of Contents

I. Introduction...402

II. Facts . . . . . . . . .403

A. Medicare Payment Process Regarding Supplemental Health Insurance Benefits ...403

•1. Requirements for Documenting Psychiatric Services....403

2. MACs and Initial Medicare Payment Determinations....404

3. RACs and the Medicare Integrity Program....405

B. Challenging an Audit Finding: Five-Stage Appeals Process....405

1. MAC Redetermination Request....406

2. QIC Reconsideration.'....406

a. Procedural Dismissal......406

b. Substantive Redetermination....406

3. Administrative…