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Centers for Medicare & Medicaid Services (CMS) OMHA

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

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

Baker Donelson

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

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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

Bass, Berry & Sims PLC

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

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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

Maynard Nexsen

Chapter 11 Relief for a CMS Debt on Appeal?

Maynard Nexsen on

The current, ultimate dilemma in the health care reimbursement legal arena is the catastrophically long wait for a hearing with an Administrative Law Judge (“ALJ”) with the Office of Medicare Hearings and Appeals (“OMHA”)....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

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

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

Benesch

CMS Low-Volume Appeals Initiative

Benesch on

On February 5, 2018, the Centers for Medicare and Medicaid Services (“CMS”) began accepting Expressions of Interest (“EOI(s)”) from Medicare fee-for-service providers to participate in a new Low-Volume Appeals Initiative...more

Arnall Golden Gregory LLP

CMS Announces Low Volume Appeal Settlement Option for Providers Mired in ALJ Backlog

On January 9, 2018, the Centers for Medicare and Medicaid Services (CMS) announced details on the new low volume appeal settlement option, which is the latest alternative available to Medicare Part A and Part B providers and...more

King & Spalding

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

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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

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

King & Spalding

HHS Announces Final Rule on Medicare Benefit Claim Appeals Process

King & Spalding on

On January 17, 2017, HHS published its final rule addressing modifications to the Medicare benefit claim appeals process. The final rule seeks to reduce the significant backlog of pending Medicare appeals and streamline the...more

Baker Donelson

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

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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

Polsinelli

OMHA Expands Settlement Conference Facilitation Program to Part A Appeals: 10 Things to Know

Polsinelli on

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

King & Spalding

Senate Finance Committee Leaders Introduce AFIRM Act to Address Medicare Appeals Backlog

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On December 8, 2015, Senate Finance Committee Chairman Orrin Hatch (R-Utah) and ranking member Ron Wyden (D-Ore.) introduced the Audit & Appeals Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 (S. 2368). ...more

Arnall Golden Gregory LLP

AGG Helps Hospice Weather the Perfect Storm of Aggressive Medicare Payment Denials and Administrative Appeal Backlog

Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with a severe backlog of cases in queue for hearing before an Administrative Law Judge...more

Polsinelli

Four Key Takeaways on the Expansion of the Medicare Appeals Settlement Conference Project

Polsinelli on

On October 15, 2015, the Office of Medicare Hearings and Appeals (“OMHA”) conducted a teleconference to address Phase II of the Settlement Conference Facilitation (“SCF”) Pilot, effective October 1, 2015. SCF, launched in...more

Polsinelli

Senate Committee Passes Bill Addressing Medicare Appeals Inefficiencies

Polsinelli on

On June 3, 2015, the Senate Finance Committee passed an original bill that aims to streamline and improve the Medicare Audit and Appeals Process. The Medicare appeals process has recently faced scrutiny from industry leaders...more

King & Spalding

HHS Seeks Public Input To Address Growing Backlog of Medicare Appeals

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The Office of Medicare Hearings and Appeals (OMHA), a division of HHS that administers the Administrative Law Judge (ALJ) hearing program for Medicare claims appeals, recently issued a Request for Information (RFI) seeking...more

King & Spalding

CMS Issues 2013 RAC Report to Congress

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On September 29, 2014, CMS released the Fiscal Year (FY) 2013 Recovery Audit Contractor (RAC) report. According to the report, RACs collected $3.65 billion in Medicare overpayments during FY 2013. In addition, the report...more

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