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
2/17/2017
/ Adjudicatory Process ,
Administrative Law Judge (ALJ) ,
Amount in Controversy ,
Centers for Medicare & Medicaid Services (CMS) ,
Decision-Making Process ,
Department of Health and Human Services (HHS) ,
Final Rules ,
Medicare ,
Medicare Advantage ,
Medicare Appeals Council ,
Medicare Claims Appeals Process ,
OMHA ,
Redeterminations
The Centers for Medicare and Medicaid Services (CMS) announced that beginning December 1, 2016, it is offering to settle certain inpatient-status claims to eligible hospitals willing to withdraw from the administrative...more
On June 28, 2016, the U.S. Department of Health and Human Services (HHS) released a series of regulatory changes in the Notice of Proposed Rule Making (NPRM) designed to curtail the massive backlog of Medicare claim appeals....more
On Feb. 25, 2016, the Office of Medicare Hearings and Appeals (OMHA) conducted a teleconference to address Phase III of the Settlement Conference Facilitation (SCF) project, which also became effective on Feb. 25, 2016. SCF,...more
On Feb. 9, 2016, the D.C. Circuit found that the lower court has the authority to order the Department of Health & Human Services (HHS) to resolve the massive backlog of Medicare appeals tied up in the administrative law...more
On Jan. 20, 2016, a federal district court in the Western District of Texas affirmed a decision of the Medical Appeals Council (Appeals Council) affirming a CMS contractor’s extrapolation methodology used to assess an...more
On February 12, 2016, CMS published the Reporting and Returning of Overpayments Final Rule (Final Rule). The Final Rule takes effect on March 14, 2016. Overall, CMS appears to have listened to stakeholders and acknowledged...more
The Centers for Medicare & Medicaid Services (“CMS”) announced that it has reduced the maximum percentage of records that providers must submit to Recovery Audit Contractors (“RAC”) through the payment auditing process...more
On August 13, 2015, the Centers for Medicare & Medicaid Services (CMS) issued instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the scope of review for...more