News & Analysis as of

Medicare Appeals Council

Health Care E-Note - Februaury 2017

by Burr & Forman on

Ransomware: A Reportable Breach? In the past several years, a huge increase has occurred in the number of electronic attacks in the United States using ransomware, a form of malware that targets and encrypts critical...more

HHS Finalizes Appeals Backlog Rule in Wake of Judicial Order

by 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

HHS Publishes Final Rule Overhauling the Medicare Appeals Process

by Baker Ober Health Law on

The Department of Health and Human Services (HHS) published its final rule revamping the Medicare appeals process at the Administrative Law Judge (ALJ) level on January 17, 2017. The final rule extensively revises federal...more

CMS Finalizes Regulations with Hope of Reducing Medicare Appeals Backlog

by Reed Smith on

On January 17, 2017, CMS published the final rule titled “Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination...more

CMS Finalizes Rule to Reduce Medicare Appeals Backlog

by Reed Smith on

In the face of growing scrutiny and now judicial pressure, the Centers for Medicare & Medicaid Services (CMS) published a final rule on January 17, 2017 implementing certain administrative and procedural actions in an effort...more

HHS Announces Final Rule to Remedy Medicare Appeals Backlog

by Arnall Golden Gregory LLP on

On January 17, 2017, the Department of Health and Human Services (HHS) released a Final Rule announcing a three-prong appellate process change in an effort to decrease the growing Medicare appeals backlog at the...more

Health Care E-Note - January 2017

by Burr & Forman on

On October 4, 2016, The Centers for Medicare and Medicaid Services ("CMS") released the final rules regarding the requirements of participation for skilled nursing facilities. One of the most significant changes to the...more

A Favorable, New Climate for Challenging Medicare Appeals

by Latham & Watkins LLP on

Over the past decade, health care providers seeking to challenge Medicare claim denials have faced increasing delays in reaching what many consider the most important step in the Medicare appeals process - a hearing before an...more

CMS Still Finding Its Way Through Significant Medicare Appeals Backlog – Proposes New Rule in an Effort to Catch Up

by Reed Smith on

In the proposed rule, CMS focuses on taking administrative actions to alleviate the backlog, including introducing the concept of precedential decisions, delegating certain administrative law judge tasks to “attorney...more

HHS Proposes Rules to Streamline the Medicare Appeals Process to Address Backlog

by Reed Smith on

The Department of Health and Human Services (HHS) has issued a proposed rule intended to address the significant backlog resulting from “an unprecedented and sustained increase” in Medicare appeals. According to HHS, its...more

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

by Baker Ober Health Law 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

HHS Proposes Significant Changes to ALJ Hearing Procedures

by King & Spalding on

HHS announced a Proposed Rule on July 5, 2016 aimed at reducing the backlog of appeals at the Office of Medicare Hearings and Appeals (OMHA) and Departmental Appeals Board (DAB) for Medicare payment and coverage...more

GAO Highlights Significant Backlog in Medicare Appeals, Routine ALJ Failure to Meet Statutory Deadlines

by Reed Smith on

The Medicare appeals process has not been able to keep up with an explosion in the number of volume, particularly at the administrative law judge (ALJ) level (Level 3), resulting in significant backlogs and widespread failure...more

CMS Posts CY 2016 Amount in Controversy Thresholds for Medicare Appeals

by Reed Smith on

CMS has published a notice announcing the annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process....more

Health Headlines: Also in the News - September 2014 #4

by King & Spalding on

CMS To Hold National Provider Call On Medicare Appeals Settlement Process – CMS has scheduled a “national provider call” on October 9, 2014, from 1:30 p.m. to 3:00 p.m. ET, to update providers on the global settlement...more

Audits and Appeals: A Routine Cost of Doing Business with Medicare

by Baker Ober Health Law on

The Centers for Medicare and Medicaid Services has unleashed an alphabet of auditors to identify overpayments. These auditors are armed with the authority to conduct pre-payment reviews, and post-payment audits, as well as...more

Federal District Court Vacates Decision of Medicare Appeals Council on Inpatient Rehabilitation Coverage

by King & Spalding on

In its recent decision in Teche Specialty Hospital v. Sebelius, the District Court for the Western District of Louisiana vacated two inpatient rehabilitation (IRF) coverage denials by the Medicare Appeals Council (MAC). The...more

HHS Asserts the Everybody-Does-It Defense

by Faegre Baker Daniels on

If that sounds familiar, your child may have a future as a lawyer for Health & Human Services. Because that’s one of the primary arguments asserted by HHS last Friday in its motion to dismiss the lawsuit by the American...more

No Judicial Review of Contractor’s Finding of a High Payment Error Rate, a Condition for Extrapolation

by Baker Donelson on

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

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