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Arnall Golden Gregory LLP

CMS Releases MLN Matters Related to Appeals of Claims Decisions

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On April 12, 2019, CMS released a Medicare Learning Network Matters article (MLN) in connection with Change Request (CR) 11042, which revises the Medicare Claims Processing Manual (Publication 100-04, Chapter 29 – Appeals of...more

Baker Donelson

D.C. District Court Strikes Down PRRB's Application of "Self-Disallowance" Jurisdictional

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In Banner Heart Hospital, et al. v. Burwell, the United States District Court for the District of Columbia (Court) held on August 19, 2016, that the Provider Reimbursement Review Board (PRRB) incorrectly declined to hear an...more

Baker Donelson

D.C. District Ct Applies Prohibition on Administrative and Judicial Review to IRF PPS Rates

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On July 25, 2016, Judge John D. Bates of the United States District Court for the District of Columbia issued a memorandum opinion broadly construing 42 U.S.C. § 1395ww(j) to prohibit administrative or judicial review of a...more

Latham & Watkins LLP

A Favorable, New Climate for Challenging Medicare Appeals

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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

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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

Arnall Golden Gregory LLP

Key Ruling In False Claims Act Case Could Have Important Implications For Defendants

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A recent decision out of a United States District Court in Alabama may signal that the playing field traditionally dominated by the government will no longer be so one-sided against providers defending against False Claim Act...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

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