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Court agrees broken appeals systems is unfair


DALLAS – A U.S. District Court’s recent opinion prohibiting CMS from recouping alleged overpayments from a provider going through the appeals process until after the administrative law judge level sends a strong message, industry stakeholders say.

Regulatory updates: Low volume appeals, prior auths


CMS will be accepting expressions of interest for low volume appeals from April 12-June 8, 2018, for all NPIs. An EOI must be submitted for each NPI.

Appeals update: Pressure mounts to expand phone demo


WASHINGTON – CMS is considering expanding a demonstration project to jurisdictions A and B that allows providers to speak with reconsideration professionals by phone to try and resolve their appeals at the second level, stakeholders say.

HHS details status of appeals backlog


FALLS CHURCH, Va. – The Office of Medicare Hearings and Appeals receives more than a year’s worth of appeals work every 24 weeks at the third level of appeals, according to a recent PDF posted to the agency’s website.

Session spotlight: Be prepared for your day in court


ATLANTA – Many HME providers end up in front of an administrative law judge to contest a reimbursement denial, but too often they don’t know what they’re up against, says speaker Ross Burris.

In brief: HHS scores win in appeals fight, Superior HealthPlan makes changes to Medline contract


NEW YORK – The D.C. Circuit on Aug. 11 ordered a federal judge to take a deeper look at whether or not the U.S. Department of Health and Human Services can clear a backlog of about 600,000 appeals by 2021, while still protecting taxpayer dollars, according to Law360.

Appeals backlog wears on

‘Hopefully we’re still in business when our cases get to a judge,’ says provider Donna Barraclough

YARMOUTH, Maine – A whopping 92% of respondents to a recent HME Newspoll say they have claims stuck at the administrative law judge level and are waiting—and waiting—for hearing dates.

HHS tries to chip away at appeals backlog

Many of proposed changes make sense, few are surprising, stakeholders say

WASHINGTON – The U.S. Department of Health and Human Services on June 28 outlined a number of proposed changes to the Medicare claims appeals process that it believes will help diminish a huge backlog.

HHS proposes changes to appeal process


WASHINGTON – The U.S. Department of Health and Human Services on June 28 issued a notice of proposed rulemaking on changes to the Medicare claims appeal process.

Demo allows providers to make their case by phone


JACKSONVILLE, Fla. – C2C Innovative Solutions, the Qualified Independent Contractor or QIC for the second level of Medicare appeals, is conducting a demonstration project that allows HME providers to discuss denied claims over the phone before a decision is made.