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Departmental Appeals Board (DAB)SELECTED DECISIONS OF THE MEDICARE APPEALS COUNCILIn January 2003, the Medicare Appeals Council (MAC) initiated the posting of certain significant decisions and actions on the web site of the Departmental Appeals Board (of which it is a component). The following decisions and actions were selected for posting since they involve the adjudication of issues that may be of interest to various stakeholders in the Medicare appeals process. They are indexed by primary topic area. This compendium of MAC decisions will be supplemented periodically. Cases with an asterisk (*) were later appealed to the federal courts. The reader may wish to research any subsequent action by the courts. TOPIC AREA Advance Beneficiary Notification (ABN)/ Notice of
Noncoverage Dental Services Durable Medical Equipment (DME)/ Certificate of Medical Necessity
(CMN) Equal Access to Justice Act (EAJA) Exclusion of Video Magnifier/Closed Circuit Television from Medicare
Coverage Home Health Services "Incident To" Services/Waiver of Overpayment Recovery Medicare Appeals Council Jurisdiction/Amount of Payment Medicare+Choice Program/Ambulance Services Medicare+Choice Program/Disenrollment Medicare+Choice Program/Drug Coverage Medicare+Choice Program/ Post-Stabilization Care Non-Physician Services Parenteral-Related Supplies/Carrier Jurisdiction Peer Review Organization (PRO) Review of Hospital Services
Physician Billing and Payment/Assistant at Surgery Physician "Opt Out" of Medicare/Private Contracts With
Beneficiaries Services Outside the United States/Estoppel Statistical Sampling |
Last revised: October 28, 2004