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ALJ Appeal

Medicare Appeals Have Become More Complex Than Ever.

(January 21, 2013):  Medicare appeals of denied claims for services are somewhat... 

Medicare Appeals — Filings with the Office of Medicare Hearings and Appeals Switch to a Central Docketing System.

(March 1, 2012):  Medicare appeals of denied claims arising out of audits conducted... 

Lose Your Medicare Appeal at Reconsideration? Don’t Throw in the Towel Just Yet — Consider the Consequences and Your Options.

(June 18, 2011):  As a review of the last several quarters of Medicare appeals statistics... 

Is Your Medicare Appeal Now at the ALJ Level? What Should You Expect?

(February 19, 2011):  Over the years, we have represented a wide variety of health... 

Be Prepared — ZPIC and QIC Representatives Are Increasing their Participation in ALJ Appeal Hearings.

(February 12, 2011):  Over the last year, we have noted an important trend when... 

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ZPIC Audits Involving Extrapolated Damages Can Bankrupt Your Practice.

(January 30, 2013): The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection... 

Has Your “Win” Before an ALJ Been Referred to the Medicare Appeals Council by the AdQIC?

(December 29, 2010):  I.    Introduction:  Many health care providers are... 

ZPIC Contractors are Turning Up the Heat.

(September 1, 2010): I.     Introduction — ZPIC Contractors Are Likely... 

Health Data Insights Begins Medical Necessity Reviews

(August 30, 2010): I.      Introduction — “Medical Necessity”... 

Hang on tight — 2010 could be rough . . .

(March 1, 2010):  The number of auditors, reviewers, investigators and prosecutors... 

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Medicare Audits

RACs Are Auditing Your Claims — What Should Physicians and other Medicare Providers Know about Appeals and Recoupment?

(July 2, 2010):  CMS’ Recovery Audit Contractor (RAC) program is now permanent and nationwide.  As we discussed in Part I of this series, while small providers were largely ignored during the demonstration program, physicians, home health, hospice, and durable medical equipment (DME) suppliers should be on the lookout for increased attention. ... [Read more of this review]

A Look at RACs — How Should Physicians and Other Providers Respond to a RAC Audit?

(June 28, 2010): In Part I of this series, we reacquainted you with the design and purpose of the now permanent Recovery Audit Contractor (RAC) Program.  Although RACs largely focused on inpatient care during CMS’ demonstration program, RACs are a real threat to small providers that don’t have the intensive compliance programs in place that most... [Read more of this review]

A Look at RACs: What Do Physicians, Home Health, Hospice, and DME Providers Need to Know?

(June 25, 2010): The purpose of this series of articles is to assess the Recovery Audit Contractor (RAC) Program from the perspective of physicians, home health, hospice, durable medical equipment (DME) providers, and other relatively small Medicare providers.  As many non-hospital providers will acknowledge, early cries of wolf by law firms and consultants... [Read more of this review]

You’ve got to be kidding. . . more Medicare audits on the way?

(March 11, 2010): Medicare audits can be extraordinarily stressful for your organization.  Are your documentation practices compliant?  If not, you should take immediate steps to address any deficient practices you might have.  New Medicare audits are on the way! According to the White House, President Obama has announced that he intends to back... [Read more of this review]

Final Rule Outlining Recoupment Limitations and the Impact on Ongoing Medicare Overpayment Appeals Cases

(February 1, 2010):  Last September, the Centers for Medicare and Medicaid Services (CMS) published its Final Rule addressing limitations on the recoupment of alleged overpayments by its Medicare contractors (e.g. Medicare Administrative Contractors and Qualified Independent Contractors).  This Final Rule finalizes how Medicare contractors are to... [Read more of this review]

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