Tag: Appeal
Pacific Therapy Access rebrands, adds DME division
August 13, 2024HME News Staff
DALLAS – Pacific Therapy Access, a provider of reimbursement strategies, prior authorization and health insurance appeals services, has rebranded to Walnut Hill Medical and added DME, health economics and market access divisions. "We are thrilled to embark on this new chapter as Walnut Hill Medical," said Chris Hanna, CEO of Walnut Hill Medical. "This transformation represents our ongoing commitment to excellence and innovation in health care solutions. Our expanded services...
Viemed prevails in ALJ appeal, Medicare returns money
January 23, 2023HME News Staff
AFAYETTE, La. – An Administrative Law Judge has ruled in favor of Viemed Healthcare, overturning all remaining disputed claims for equipment services, related to findings from the Office of Inspector General.
As a result, Medicare Administrative Contractors returned 100% of the previously remitted funds to Viemed.
“We are extremely pleased with the judge’s decision in this matter, which reaffirms the high integrity of our clinical protocols and sets the record...
Viemed balances business, wins at QIC level
May 20, 2022Theresa Flaherty, Managing Editor
LAFAYETTE, La. – Viemed’s latest growth figures signal that business is returning to something close to normal, company execs said during a recent call to discuss first quarter financial results for 2022.
The company reported core net revenues increased 18% compared to the same period last year.
“To sum up the overall theme of the first quarter, I would say execution, fueled by demand, driven by return-to-normal course of business,” said CEO Casey Hoyt.
Viemed...
Provider vindicated but wary
February 25, 2022Liz Beaulieu, Editor
AMARILLO, Texas – Provider Josh Britten appealed $650,000 worth of denied Medicare claims back in 2015 and it took him six years and more than $100,000 to get it back. And he’s one of the lucky ones – he had the resources to stick with it.
“We filed our third appeal in 2015 and we finally received a decision in 2021,” said Britten, CEO of BritKare Home Medical. “We were six years waiting on a decision (at the ALJ level) that should have taken 90 days.”
Here’s...
Andrea Stark makes case for making demo permanent
September 10, 2021Liz Beaulieu, Editor
YARMOUTH, Maine – The contract may be running out for a demonstration that allows HME providers to try to resolve denied claims by phone, but Andrea Stark says, “We’re onto something here,” and hopes CMS will make it a permanent part of the statement of work for the QIC.
The QIC, which is run by Maximus, recently announced it is winding down the demo per a contract that ends Dec. 31, 2021.
“Clearly, DME is complicated and suppliers feel better when...
OMHA reduces ALJ backlog
November 19, 2020HME News Staff
WASHINGTON - The Office of Medicare Hearings and Appeals is back to operating at full capacity and is making its way through a backlog of appeals at the Administrative Law Judge level, AAHomecare reports. As of Oct. 31, 2020, there are about 85,000 DMEPOS appeals pending at the ALJ, a decrease of 51% compared to nearly 173,000 in 2019. OMHA also reported that the average wait time for an ALJ hearing is still four years, but it believes that should decrease as judges work their way through the backlog....
Q&A: Atty Matthew Fischer on appeals
October 28, 2019Liz Beaulieu, Editor
MIAMI - Matthew Fischer, a former senior attorney adviser for the Office Medicare Hearings and Appeals, has seen the ugliness of the appeals backlog from the inside. Here's what Fischer, now an attorney with the Zumpano Patricios, had to say about how to work a flawed system.
HME News: What did the appeals system look like from the inside?
Matthew Fischer: When I got there in 2011, I'd be looking at cases from two or three years ago. I thought, what is going on? They just didn't...
HHS reports 25% reduction in appeals backlog
October 16, 2019HME News Staff
WASHINGTON - The Department of Health and Human Services has reduced the backlog of Medicare appeals at the administrative law judge level by 25% through June 30, according to a status report provided to a federal court and obtained by the American Hospital Association.
The status report is part of a federal court ruling last year that established annual deadline-based targets for reducing the backlog of Medicare appeals at the ALJ level.
From Nov. 1, 2018, through the end of the third quarter...
CMS expands phone demo
October 23, 2018HME News Staff
JACKSONVILLE, Fla. - CMS will expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases to jurisdictions A and B on Nov. 1.
The agency cited “strong support from the supplier community and the initial success of the demonstration” as reasons to expand the phone demo.
“Effective on or after Nov. 1, the DME QIC will offer telephone discussions and/or re-openings to DME suppliers within the DME...
Lack of unified stance on settlements, poll finds
October 12, 2018Liz Beaulieu, Editor
YARMOUTH, Maine - It turns out, even with the huge backlog of Medicare appeals stuck at the administrative law judge level, whether or not to accept a settlement is as divisive an issue as it gets in the HME industry.
The respondents to a recent HME Newspoll were evenly divided on the issue, with 50% feeling the need to take a stand and 50% feeling the need to take the money and run.
“Why should CMS be left off the hook and rewarded for messing things up in the first place?” wrote...