If I won my case, why do I need to worry about an appeal?
What are the steps of an appeal?
Nevada Workers Compensation: Hearings and Appeals Overview
If I wasn't happy with my lawyer, can I appeal and show evidence I wanted to present?
Can I collect my judgment if the other side is appealing?
What is an appeal and how do I know if I should appeal?
Bill on Bankruptcy: What's in the $83M ResCap Examiner's Report?
N.Y. Anti-Terror Law Diminishes Pursuit of Terrorism: Lawyer
As we reported in previous Payment Matters articles, the United States District Court for the District of Columbia has issued inconsistent opinions regarding Medicare's policy not to allow bad debt when that bad debt is still...more
A recent decision out of a United States District Court in Alabama may signal that the playing field traditionally dominated by the government will no longer be so one-sided against providers defending against False Claim Act...more
On June 3, 2015, the Senate Finance Committee passed an original bill that aims to streamline and improve the Medicare Audit and Appeals Process. The Medicare appeals process has recently faced scrutiny from industry leaders...more
This Week: House Ways & Means Committee Holds Markup; Makes Significant Legislative Changes to Health Care Bills... Senate Finance Committee Holds Markup on Medicare Appeals Process Bill... CMS Issues Final Rule on...more
It’s a measure of the backlog in DSH (for Disproportionate Share Hospital) payment appeals that CMS is still issuing rulings for appeals applicable to treatment of patients before October 1, 2004. On April 24 CMS issued...more
On Tuesday, March 10, 2015, the Court of Appeals for the Federal Circuit reversed and remanded a decision by the Court of Federal Claims, which permitted the Centers for Medicare and Medicare Services (CMS) to include...more
On January 23, 2015, the United States Department of Labor (DOL) filed a notice of appeal with the United States Court of Appeals for the District of Columbia (District Court) challenging two rulings in the case of Home Care...more
CMS officially added a new Section 3.9 to the Medicare Program Integrity Manual, effective October 27, 2014. These provisions instruct Medicare Administrative Contractors (MACs) to assign a physician to participate at...more
The Office of Medicare Hearings and Appeals (OMHA), a division of HHS that administers the Administrative Law Judge (ALJ) hearing program for Medicare claims appeals, recently issued a Request for Information (RFI) seeking...more
On October 27, 2014, the Centers for Medicare & Medicaid Services (CMS) made a concession—a very small one—to hospitals racing against the looming October 31, 2014, deadline for accepting the offer of 68 cents on the dollar...more
Deferring to CMS, the United States Court of Appeals for the Sixth Circuit recently upheld the agency’s treatment of hospitals’ payments to employees for wage index purposes. Atrium Medical Center v. U.S. Dept. of Health &...more
In This Issue:
- U.S. Court of Appeals Holds that Physicians’ Employer is Personally Liable for Costs Associated with The H- 1B Process and Obtaining a Waiver of the Two- Year Home Residency Requirement
It’s no secret that CMS is drowning in appeals from denials of Medicare claims for inpatient care. The number of pending appeals was estimated at half a million back in February, and it’s only grown since then. One reason...more
On August 29, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a deal to hospitals willing to drop pending inpatient-status claims appeals. These appeals have grown exponentially in recent years due to the...more
With little fanfare just before the Labor Day weekend, CMS announced a program in which it would enter into administrative agreements with eligible providers in exchange for the providers’ withdrawal of pending appeals...more
The Office of Medicare Hearings and Appeals (OMHA), which oversees the Administrative Law Judge (ALJ) level of appeal, recently posted two important announcements regarding a new Statistical Sampling Initiative (SSI) and...more
Before a Medicare contractor can use extrapolation to determine an overpayment amount, the Medicare statute requires that it must make a finding that there is a sustained or high level of payment error or that documented...more
On January 21, 2103, the U.S. Supreme Court unanimously held in Sebelius v. Auburn Regional Medical Center that the Medicare statute does not permit the time period for filing an appeal with the Provider Reimbursement Review...more
The American Hospital Association (AHA) published its RACTRAC Survey results for the third quarter of 2012. The AHA created the survey in response to the lack of information released by CMS on its Medicare RAC program. For...more
The OIG recently published a report reviewing the implementation of 2005 regulations regarding the administrative law judge (ALJ) level of appeals, the third level of the Medicare appeals system. The 2005 regulatory changes...more
CMS recently issued a notice [PDF] that the amount in controversy necessary to pursue certain appeals will increase beginning January 1, 2013. The increase in the amount in controversy threshold relates to Administrative Law...more
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