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ALJ appeals

Settlement update: A non-option option for appeals


WASHINGTON – CMS has rolled out a new settlement option for low-volume appeals, but it’s not likely HME providers will take the agency up on its offer, stakeholders say.

CMS offers appeals settlement


WASHINGTON – CMS recently announced a low volume appeals settlement for Part A and Part B appeals at the Office of Medicare Hearings and Appeal and the Medical appeals Council.

ALJ Appeals: Pay attention to details

Q. What tricks and tips do you have for suppliers appealing a decision to the Departmental Appeals Board (DAB)?

A. If CMS or a supplier disagrees with an Administrative Law Judge’s (ALJ) decision, the matter may be appealed to the Departmental Appeals Board (DAB).

ALJ Appeals: Be prepared from the start

Q. How can I bolster my chances of success at an ALJ hearing?

A. A supplier that disagrees with a Qualified Independent Contractor’s reconsideration decision is entitled to a hearing before an administrative law judge.

ALJ Appeals: Increase your success rate

Q. What can suppliers do to increase their chances of success during the Medicare appeals process?


ALJ Appeals: Pay attention to details

Q. What are some best tips for defending claims—from ADR letters to ALJ appeals?

A. A home medical equipment supplier can protect its profit margins from recoupment by establishing a compliance culture that collects adequate documentation and submits proper billing claims, but it is equally important for a supplier’s bottom line to defend and appeal erroneous Medicare recoupments.

OMHA pilots appeals program


WASHINGTON – The Office of Medicare Hearings and Appeals (OMHA) has announced a pilot program aimed at helping providers resolve claims appealed to the administrative law judge (ALJ) level.