News & Analysis as of

Administrative Law Judge (ALJ) MACs

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

King & Spalding

Fifth Circuit Says Federal Court has Jurisdiction to Grant Injunction Against Recoupment of Alleged Overpayment until ALJ Hearing

King & Spalding on

A March 27, 2018 decision by the United States Court of Appeals for the Fifth Circuit, Family Rehabilitation Incorporated v. Azar, II, No. 17-11337 (“Family Rehab”), potentially paves the way for Medicare providers to seek...more

Latham & Watkins LLP

A Favorable, New Climate for Challenging Medicare Appeals

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

Arnall Golden Gregory LLP

CMS Limits the Scope of Review for Certain Redeterminations and Reconsiderations

For providers who have received inconsistent or varying reasons for denial while navigating through the Medicare appeals process, the Centers for Medicare & Medicaid Services (CMS) has provided much-needed relief in the form...more

Baker Donelson

CMS Instructs MACs to Participate in ALJ Hearings

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CMS officially added a new Section 3.9 to the Medicare Program Integrity Manual, effective October 27, 2014. These provisions instruct Medicare Administrative Contractors (MACs) to assign a physician to participate at...more

King & Spalding

CMS Provides for Greater MAC Involvement in ALJ Hearings

King & Spalding on

CMS recently issued Transmittal 543, Change Request 8501 in which it instructs Medicare Administrative Contractors (MACs) to, among other things, defend their medical review decisions through the Administrative Law Judge...more

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