Be prepared for your day before ALJ hearing

ATLANTA - Many HME providers end up in front of an administrative law judge (ALJ) to contest a reimbursement denial, but too often they don't know what they're up against.

At Medtrade in Atlanta, in “What Really Happens In An ALJ Hearing?” Ross Burris, an attorney with the Kansas City-based law firm Polisinelli, was part of a panel that walked attendees through how to prepare and manage an ALJ hearing.

HME News: Why is there a need for a session like this?

Ross Burris: A lot of providers decide to handle these hearings without counsel or consultant. It's often a financial decision. The problem is, they don't know how the proceedings work.

HME: How can providers make the most of their time at these brief hearings?

Burris: They definitely need to be prepared. They need to understand their documentation and the basis for the denial. They also need to know how they're going to respond because these hearings happen very quickly. The judges don't have a lot of time, so providers need to be ready to get out their important points about why the claims should be paid

HME: What are the pitfalls of these hearings?

Burris: People aren't preparing at the early stages of the appeal process with a mind toward an ALJ hearing. They've probably handled the first couple stages on their own, so they don't have the necessary documentation. But by the time it gets to the ALJ it's too late. They need to think of it as an audit and get a plan early.

HME: Aren't providers often successful during ALJ hearings? Why?

Burris: More than half of providers are successful, and the fact is the prepared provider is going to have a much better track record.

HME: If attendees take away one thing from this session, what should it be?

Burris: Because of the hearing backlog being almost two full years at the ALJ level, people are waiting a long time to get their day in court. They must be prepared to have all their documentation, and have everybody lined up if they're going to have physicians or nurses testify.