News & Analysis as of

Administrative Law Judge (ALJ) Medicare Medicare Claims Appeals Process

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

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

Cozen O'Connor

Court of Appeals Finds Jurisdiction In Medicare Appeals Backlog Case

Cozen O'Connor on

The Fifth Circuit has recently held that its courts have jurisdiction to hear a lawsuit seeking to enjoin Medicare from recouping funds until after a hearing because (1) the provider’s claim is collateral to the underlying...more

Bass, Berry & Sims PLC

CMS Offers Expanded Settlement Options to Reduce Appeals Backlog

Bass, Berry & Sims PLC on

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

Court of Appeals Reverses D.D.C. Order Requiring HHS to Eliminate Medicare Appeals Backlog by December 31, 2020

Baker Donelson on

Hopes were dashed for sooner relief from the backlog of Administrative Law Judge (ALJ) appeals. With the backlog of Medicare reimbursement appeals steadily growing, a reversal by the U.S. Court of Appeals for the District of...more

Burr & Forman

Medicare Claims Appeals Process - A Refresher

Burr & Forman on

With the increased audit activity we are seeing among the alphabet soup of Medicare contractors— RACs, ZPICs, SMRCs, CERTs, etc.—now appears to be a good time for a refresher on the Medicare claims appeals process. Due to...more

Polsinelli

HHS Finalizes Appeals Backlog Rule in Wake of Judicial Order

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

Baker Donelson

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

Baker Donelson 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

Baker Donelson

Only One Short Bite of the Apple: Change in the Medicare Enrollment Appeals Process

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In keeping with the trend to strengthen its authority to deny an enrollment or revoke Medicare billing privileges, CMS has modified the appeals process in a manner that will significantly shorten the time allotted to mount an...more

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