Medicare (Recommendations)

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In 1986, the Administrative Conference undertook a broad overview of the administrative procedures employed by the federal government (primarily the Health Care Financing Administration within the Department of Health and Human Services) in administering and deciding appeals under the Medicare program. Recommendation 86-5, Medicare Appeals, 1 CFR...

As the Administrative Conference noted in Recommendation 86-5,1 the Medicare program relies heavily on implementation of federal requirements by localized carriers, intermediaries and, increasingly, peer review organizations (PROs).

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The Medicare program, since 1965, provides health insurance for nearly all elderly and most disabled Americans. The program relies on hospitals, nursing homes and other health care institutions (under “Part A” of the program) and physicians and suppliers (under “Part B”) to provide benefits to its beneficiaries.

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