Stage Reg

My friend lost her baby at 7 months..........?

jst wntd 2 knw tht is it possible for a lady 2 loose her baby at this stage & not come 2 knw fr nxt 2-3 dys aftr tht when she went for reg.check her doc said baby is no more there,
She says that she didn't even realise(but wht i wnt 2 say tht she must hv been feeling baby moving earlier & aftr tht if there was no movement thn will she not come 2 knw).
Is it possible.......plz ans?

Anything is possible. I have a hard time reading your post, had to read over and over to get the just of it.

Seems like your friends' baby passed while still in her uterus. It is possible that the cord wrapped around baby's neck or some other act of god, to cause the baby to pass on. I would have, if i were your friend, noticed that the baby had stopped moving, and went to the doctor, Maybe her baby was a "lazy" baby that didin't move much, so she didn't realize it as soon as other moms would.

My heart goes out to your friend. One of my babies was born alive, but died at 10 days old from complications of premature birth.

Physicians, providers and suppliers providing services under Part A of Medicare, who have been subject to Medicare audits or claim denials resulting in overpayment demands, are aware that, currently if a Medicare fiscal intermediary identifies an alleged overpayment, the intermediary will immediately begin recouping the alleged overpayment without first granting the provider time to submit an appeal. Specifically, the fiscal intermediary standard system ("FISS") adjusts a claim, and if claims are in the system, immediately recoups. This process does not provide Part A providers time to appeal an overpayment determination before the fiscal intermediary begins withholding funds. The Centers for Medicare and Medicaid Services ("CMS" or "Medicare") recently published a One-Time Notification, which instructs fiscal intermediaries and carriers regarding limitations on Medicare's authority to recoup certain overpayments.

The One-Time Notification addresses recent changes made to the Social Security Act, which limit Medicare's authority to recoup alleged overpayments during the Medicare appeals process. Section 935 (a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ("MMA") added Section 1893 (f) (2) to the Social Security Act. This portion of the law restricts Medicare's authority to recoup overpayments during parts of the Medicare appeals process. Pursuant to Section 1893 (f) (2) (A):

In the case of a provider of services or supplier that is determined to have received an overpayment under this title and that seeks a reconsideration by a qualified independent contractor on such determination... the Secretary may not take any action (or authorize any other person, including any Medicare contractor...) to recoup the overpayment until the date the decision on the reconsideration has been rendered...

Prior to the enactment of Section 1893 (f) (2), a provider's appeal of an overpayment determination did not impact Medicare's authority to recoup an alleged overpayment. Medicare was authorized to recoup alleged overpayments at all times during the appeals process. Section 1893 (f) (2) limits Medicare's authority to recoup alleged overpayments during the appeals process. Generally speaking, the law requires that if a provider seeks a reconsideration of an overpayment determination, then Medicare and its contractors may not recoup the alleged overpayment until the qualified independent contractor ("QIC") issues a reconsideration decision.

Significantly, the QIC reconsideration stage of appeal is the second stage in the Medicare appeals process. The statute is unclear whether Medicare may recoup or withhold funds during the first stage of appeal (the redetermination stage), and after this stage until a request for reconsideration has been filed. Notably, Medicare has not yet adopted regulations implementing Section 1893 (f) (2), which would provide clarification. A proposed rule was published September 22, 2006,[1] however, a final rule has not yet been adopted.

In the absence of specific regulatory language to the contrary, an argument can be made that the statute prohibits Medicare from recouping once an appeal has been made at the first stage of appeal (redetermination) through the second stage of appeal (reconsideration). However, an argument can also be made that the statute only prohibits Medicare from recouping during the reconsideration stage of appeal, and thus Medicare would be permitted to recoup during the first stage of appeal, until a request for reconsideration is filed.

The One-Time Notification addresses the statutory ambiguity and adopts the recoupment policies articulated in the proposed rule. The One-Time Notification specifically addresses Part A overpayments, and instructs intermediaries that the receipt of a timely and valid request for redetermination at first stage of appeal will trigger limitation on recoupment. Specifically, the recoupment process will be as follows:

§ Once the intermediary renders an unfavorable initial determination, finds an overpayment to exist, and adjusts the claim in FISS, withholding will automatically begin 40 days from the date of initial determination.

§ If a provider files a request for redetermination in the 40 days following the adverse initial determination, then Medicare will not initiate withhold activities. Notably, pursuant to the federal regulations governing the Medicare appeals process, a provider has 120 days from the date of initial determination to file its request for redetermination. However, if the provider chooses to utilize this entire time period, then the provider must be aware that Medicare will begin withholding until the request for redetermination is filed.

§ If the redetermination decision results in a full or partial affirmation of the overpayment, then the intermediary may begin withholding funds beginning 60 days and no later than 75 days after giving notice, unless the provider first appeals a request for reconsideration to the QIC.

§ The intermediary may not initiate recoupment once a valid and timely request for reconsideration has been filed. Notably, pursuant to the federal regulations governing the Medicare appeals process, a provider has 180 days from the date of redetermination decision to file its request for reconsideration. However, as noted above, the intermediary may begin withholding between 60 and 75 days from the date of redetermination decision. It may be tempting for providers to quickly appeal an unfavorable redetermination decision to stop the intermediary from withholding funds. However, it may be advantageous for the provider to take some additional time to carefully put together its appeal. The regulations require providers to present all evidence, allegations of fact or law related to the issues in dispute, and explain its reasons for disagreement when filing a reconsideration request. Absent good cause, the failure of a provider to submit evidence prior to issuance of the reconsideration decision precludes subsequent consideration of the evidence.

§ Once the qualified independent contractor issues its decision, the intermediary may begin recoupment, regardless of whether the provider subsequently proceeds to the third stage of appeal and requests an Administrative Law Judge hearing.

The CMS One-Time Notification is effective July 1, 2008 and will be implemented July 7, 2008. The notification is available online at www.cms.hhs.gov/transmittals/downloads/R322OTN.pdf

http://www.racattorneys.com

[1] 71 Fed. Reg. 55404 (September 22, 2006).

Reg Varney (1916- 2008)

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