On January 3, 2022, the U.S. Court of Appeals for the Fifth Circuit Court reversed the decision of the District Court for the Western District of Louisiana dismissing for lack of jurisdiction a Medicare provider’s suit...more
Although newly released data from the Office of Medicare Hearings and Appeals (OMHA) suggests that the Medicare claim appeals backlog might be decreasing, OMHA's case processing time and recent litigation challenging the...more
In the wake of its recent efforts to settle claims (see the 2014 initial hospital inpatient settlement and the 2016 second-round wave), in the heavily backlogged Medicare administrative appeals system, CMS has introduced a...more
The Office of Medicare Hearings and Appeals (“OMHA”) recently expanded the Settlement Conference Facilitation (“SCF”) program, an alternative dispute resolution process, to allow more providers and suppliers with pending Part...more
In preparation for the upcoming expansion of its Settlement Conference Facilitation (SCF) program, the Office of Medicare Hearings and Appeals (OMHA) has directed interested providers and suppliers to review the SCF Expansion...more
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
On February 5, 2018, the Centers for Medicare and Medicaid Services (“CMS”) began accepting Expressions of Interest (“EOI(s)”) from Medicare fee-for-service providers to participate in a new Low-Volume Appeals Initiative...more
In a Medicare Learning Network call on January 9, the Centers for Medicare and Medicaid Services provided specifics related to its new “Low Volume Appeals Settlement” initiative, allowing qualifying providers to settle...more
On November 3, 2017, CMS announced that it plans to implement two appeals settlement initiatives designed to decrease the backlog of Medicare appeals pending at the Medicare Appeals Council (MAC) of the Department Appeals...more
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
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
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
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
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 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
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
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
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
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
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