“Finally Friday!” ALJ Training Given by OMHA, CMS and MAC

FRIDAY December 2, 2016:

“ALJ Training Given by


We finally get a peek behind the curtain and…
maybe this is how Dorothy felt?

behind curtain

Jessica Gustafson of The Health Law Partners pulls back the curtain for us

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Sponsored by The Health Law Partners and ZirMed

THIS WEEK, we get to pull back that curtain that hides what CMS, OMHA and the Medicare Appeals Council (MAC, but not the MAC you usually think of – also called the DAB, the Departmental Appeals Board) have been telling the ALJs about deciding your appeals! Finally!

Now, perhaps you didn’t notice, but there seems to be some difference between what the ALJs were being taught about how to decide appeals, especially since the infamous Two Midnight Rule went into effect with CMS-1599, the FY 2014 IPPS Final Rule (aka, “It Came From CMS”). Well anyway, not too long ago, the number of decisions favorable to the providers was significantly higher before the huge backlog occured at OMHA, beginning in FY 2013, and continuing to the present day.

jessica gustafson

Jessica is a frequent speaker nationwide and at our show.

Recently, The Health Law Partners filed a Freedom of Information Act (FOIA) request to receive copy of any and all training materials from the joint training sessions that occurred using policy experts from OMHA, CMS and the MAC, during the period January 1 2015 thru March 31 2016.

Now, Jessica Gustafson, one of their founding partners, and a frequent speaker on our shows will present a review of what she learned from the materials, which included 264 pages, making up three presentations, from October 2015, November 2015 and March 2016.

So… join us as we will be discussing what Jessica learned about:

  • WHAT were the topics covered in those three sessions;
  • WHAT might have been discussed in the mysterious “Topic Discussion” in the October 2015 session;
  • WHAT are the ALJs being taught about “addressing applicable policy” in their decisions;
  • WHAT did OMHA focus on, relating to “re-educating” the ALJs on procedures?

So join us, share your own insights and bring your questions for us!

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