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Medicare OMHA

Arnall Golden Gregory LLP

Healthcare Providers Could Finally Have Their Day in Court: Supreme Court Holds That Defendants Are Entitled to Jury Trials When...

On June 27, 2024, the Supreme Court of the United States released its opinion in SEC v. Jarkesy, a case involving a Securities and Exchange Commission (“SEC”) enforcement action for civil penalties against an investment...more

Oberheiden P.C.

What Does it Take to Win Medicare Appeals in 2024?

Oberheiden P.C. on

Lots of health care service providers find themselves in the position of needing to file a Medicare appeal. Despite the systematic nature of modern Medicare billing, wrongful denials remain common, and errors during Medicare...more

Baker Donelson

HHS Expands Eligibility for Medicare Appeal Settlement Conference Facilitation Process

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On August 11, 2020, the Department of Health and Human Services announced that it is expanding the alternative dispute resolution process known as Settlement Conference Facilitation (SCF) for 2020. Under the expansion,...more

Baker Donelson

Recent Litigation Underscores Continued Difficulties with the 'Logjam' of the 'Colossal' Medicare Claim Appeals Backlog

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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

Fox Rothschild LLP

Medicare Appeals And Audit Waivers Amid The COVID-19 Pandemic

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In the event of a national disaster or emergency under the Stafford Act or the National Emergencies Act and a Public Health Emergency Declaration by government officials, the Department of Health and Human Services (HHS)...more

King & Spalding

Senators Grassley and Wyden Reintroduce Legislation to Reduce Medicare Appeals Backlog

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On December 17, 2019, Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) reintroduced legislation to address the backlog of Medicare appeals cases awaiting review before an...more

Baker Donelson

CMS Offers 100 Percent or 69 Percent Recovery Settlement Option for Backlogged Medicare IRF Claim Appeals

Baker Donelson on

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

Arnall Golden Gregory LLP

Summary Recap and Key Takeaways from AHLA’s Medicare and Medicaid Payment Issues Conference

Every year, health lawyers, providers, consultants, and government experts from across the country convene in Baltimore for the American Health Lawyers Association’s Institute on Medicare and Medicaid Payment Issues, the most...more

McDermott Will & Emery

Third Time Might Be the Charm: District Court Orders HHS to Clear the Medicare Appeals Backlog by 2022

McDermott Will & Emery on

The US District Court for the District of Columbia issued a mandamus order on November 1 requiring HHS to clear the Medicare administrative appeals backlog by the conclusion of 2022. A dedicated $182.3 million appropriation,...more

Bass, Berry & Sims PLC

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

Bass, Berry & Sims PLC on

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

Arnall Golden Gregory LLP

Momentum is Building: Another Federal Court Stops Recoupment During a ZPIC Appeal, Citing Backlog in Medicare Appeals Process as...

Medicare’s implementation of post-payment review through overly aggressive zone program integrity contractors (ZPICs) and unified program integrity contracts (UPICs), combined with an ineffective review process at the first...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

Mintz - Health Care Viewpoints

HHS Announces a “Settlement Express” Option for Medicare Appeals

HHS’s Office of Medicare Hearings and Appeals (OMHA) has long faced a backlog in Medicare appeals to Administrative Law Judges (ALJs). In an effort to address this backlog, OMHA established a Settlement Conference...more

K&L Gates LLP

OMHA to Host Call on Expanded Settlement Conference Facilitation on May 22, 2018

K&L Gates LLP on

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

Arnall Golden Gregory LLP

Office of Medicare Hearings and Appeals To Hold Open Door Call on Upcoming Expansion of Settlement Conference Facilitation Program

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

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

Baker Donelson

The New Option in Town: Applying for the Low Volume Appeals Settlement

Baker Donelson on

In November 2017, the Department of Health and Human Services (HHS) announced new settlement options for providers and suppliers stuck in the backlog of the Medicare appeals process. One of the new options available is the...more

Bricker Graydon LLP

Low Volume Appeals settlement option announced

Bricker Graydon LLP on

The Centers for Medicare & Medicaid Services (CMS) recently announced the Low Volume Appeals (LVA) settlement agreement option, which allows Medicare Fee-For-Service providers, physicians and suppliers (Appellants) to receive...more

King & Spalding

CMS Announces Plans to Expand Settlement Options to Decrease Medicare Appeals Backlog

King & Spalding on

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

Polsinelli

Update: HHS Announces Two Additional Medicare Appeals Settlement Initiatives

Polsinelli on

On Nov. 3, Health & Human Services (HHS) announced two additional initiatives to address the mounting Medicare appeals backlog at the Administrative Law Judge (ALJ) level: (i) expand the Settlement Conference Facilitation...more

McDermott Will & Emery

Medicare Appeals Backlog: A Setback and New Opportunities for Providers

McDermott Will & Emery on

As of June 2017, the Office of Medicare, Hearing and Appeals (OMHA) had 607,402 appeals pending with a current estimated wait time of three years for an Administrative Law Judge to process a provider’s appeal. At this rate,...more

King & Spalding

DC Circuit Court Remands Medicare Appeals Backlog Case

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Last week, the United States Court of Appeals for the District of Columbia Circuit reversed and remanded the Medicare appeals backlog case American Hospital Association v. Price to the district court. As previously reported,...more

King & Spalding

HHS Claims Budget Increases May Mean Reductions to Medicare Appeals Backlog

King & Spalding on

In a status report filed in connection with the American Hospital Association v. Price case, HHS projects significant reductions to the Medicare appeals backlog if the “legislative and budgetary measures proposed” in the...more

King & Spalding

Senate Finance Committee May Tackle Medicare Appeals Backlog

King & Spalding on

According to Kimberly Brandt, Chief Oversight Counsel for the Senate Finance Committee’s majority staff, the Senate Finance Committee could reintroduce the Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of...more

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