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A Member of Catholic Health Services of Long Island
A High Acuity High Occupancy Community Teaching Hospital with 437 Beds
8600 Medicare discharges in 2008
Medical Necessity Denials 28 23 5 # of Appeals at 2 nd Level (QIC) Upheld Overturned 105 28 77 # of Appeals at 1 st Level (F.I.) Upheld Overturned 113 8 # of Medical Necessity Denials No Appeal Total Good Samaritan Hospital Medical Center
Medical Necessity Denials (cont’d) 88% Overall Medical Necessity Win Rate 4 3 1 # of Appeals at 4 th Level (MAC) Upheld Pending 23 4 19 # of Appeals at 3 rd Level (ALJ) Upheld Overturned