News & Analysis as of

Department of Health and Human Services (HHS) Medicare Claims Appeals Process

Baker Donelson

HHS Expands Settlement Conference Facilitation for Medicare Claims Appeals

Baker Donelson on

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

Cozen O'Connor

Court of Appeals Finds Jurisdiction In Medicare Appeals Backlog Case

Cozen O'Connor on

The Fifth Circuit has recently held that its courts have jurisdiction to hear a lawsuit seeking to enjoin Medicare from recouping funds until after a hearing because (1) the provider’s claim is collateral to the underlying...more

Bass, Berry & Sims PLC

CMS Offers Expanded Settlement Options to Reduce Appeals Backlog

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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

Holland & Knight LLP

Trump Administration Fiscal Year (FY) 2019 Budget and Healthcare Programs

Holland & Knight LLP on

The Trump Administration on Feb. 12 released its Fiscal Year (FY) 2019 budget request, titled "An American Budget." Unlike last year's budget, which was released in late May, the release of this budget conforms to the typical...more

Baker Donelson

Court of Appeals Reverses D.D.C. Order Requiring HHS to Eliminate Medicare Appeals Backlog by December 31, 2020

Baker Donelson on

Hopes were dashed for sooner relief from the backlog of Administrative Law Judge (ALJ) appeals. With the backlog of Medicare reimbursement appeals steadily growing, a reversal by the U.S. Court of Appeals for the District of...more

Polsinelli

Update: HHS Decides Appeals Backlog Rule

Polsinelli on

On January 17, 2017, HHS published a rule addressing public comments and finalizing changes to the Medicare benefit claim appeals processes that were proposed on July 5, 2016. Although there was initially some speculation...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

BakerHostetler

I’ll Gladly Pay You 10 Years From Today for Care Already Provided

BakerHostetler on

Most providers whose claims have been determined to be improper by the Recovery Audit Contractors (RACs) under the Medicare Recovery Audit Program have discovered that the appeals backlog “is incontrovertibly grotesque.”...more

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