News & Analysis as of

Administrative Law Judge (ALJ) Centers for Medicare & Medicaid Services (CMS) Medicare Claims Appeals Process

Bass, Berry & Sims PLC

Judicial Opinions Support Delay of Recoupment from Audit Appeals Until After ALJ Hearings in Certain Circumstances

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Recent opinions by the Fifth Circuit, the Northern and Southern Districts of Texas, and the District of South Carolina offer hope to providers seeking relief from substantial monetary recoupments during the Medicare appeals...more

Baker Donelson

HHS Expands Settlement Conference Facilitation for Medicare Claims Appeals

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The Department of Health and Human Services (HHS) announced on November 3, 2017 additional settlement options for providers and suppliers in an effort to improve the Medicare claims appeals process, which included (1) the Low...more

K&L Gates LLP

Expanded Option to Settle Medicare Appeals

K&L Gates LLP on

In an effort to resolve its backlog of Medicare appeals, the Department of Health & Human Services’ Office of Medicare Hearings and Appeals (OMHA) established a Settlement Conference Facilitation (SCF) pilot program in June...more

Bass, Berry & Sims PLC

CMS Offers Expanded Settlement Options to Reduce Appeals Backlog

Bass, Berry & Sims PLC on

In January 2018, Centers for Medicare & Medicaid Services (CMS) announced additional information regarding a new Low Volume Appeals (LVA) settlement option and an expanded Settlement Conference Facilitation (SCF) as part of...more

Polsinelli

HHS Finalizes Appeals Backlog Rule in Wake of Judicial Order

Polsinelli on

The U.S. Department of Health and Human Services (HHS) released a Final Rule aimed at reducing and eventually eliminating the backlog of more than 650,000 claims currently awaiting adjudication by an administrative law judge...more

Baker Donelson

Medicare Appeals Backlog: HHS' Response to the Decade-Long Delay in Reviewing Appeals

Baker Donelson on

The Department of Health and Human Services (HHS) published its proposed rule [PDF] revamping the Medicare appeals process at the Administrative Law Judge (ALJ) level on July 5, 2016. The proposed rule extensively revises...more

Baker Donelson

Only One Short Bite of the Apple: Change in the Medicare Enrollment Appeals Process

Baker Donelson on

In keeping with the trend to strengthen its authority to deny an enrollment or revoke Medicare billing privileges, CMS has modified the appeals process in a manner that will significantly shorten the time allotted to mount an...more

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