“Finally Friday!” What Do You Say to an ALJ – Part 2

FRIDAY August 28, 2015:

“Insights on ALJ Hearings
and ALJ Pre-hearings

Former ALJ and Veteran
Appeals Attorneys Reveal
Keys to Success…

Get the Handouts

RACs & MACs seem to have taken this to heart, over the past year...

RACs & MACs seem to have taken this to heart, over the past year…

Strategies for winning appeals at the third level of the Medicare Appeals process were, once upon a time, fairly simple. Woody Allen’s advice about how “80% of success is showing up,” was a fair description of providers’ experience with ALJ hearings, prior to FY2014, as providers were winning an average of 77% of the time, some even winning over 90% of the time. All that changed, however, and now remains a bit of a mystery as to how things will shake out in the near future, due to various factors.

Legendary rascal, former ALJ, author, and speaker on Medicare, hearing strategy, presentations, ethics, the art of advocacy, Bob is the founder and CEO of the Advocacy Akademie. In other words, he belongs on our faculty.

Legendary rascal, former ALJ, author, and speaker on Medicare, hearing strategy, presentations, ethics, the art of advocacy, Bob is the founder and CEO of the Advocacy Akademie. So, yeah, he sorta belongs on our faculty.

To help provide more insights into what has become a more difficult process, we invited former ALJ Bob Soltis to join us, along with veteran appeals attorneys Jessica Gustafson and Abby Pendleton. In previous shows, these three have given great advice on a more general nature of how to handle ALJ hearings. Recently, however, we’ve been hearing about some new challenges, and we also realized we have never discussed the Pre-hearings that may pop up on occasion. So, we asked them to speark to you this week about those exact issues.

On this week’s show, we will be discussing:

  • Jessica and Abby presented a full 1-hour review of recommended appeal strategies at the PAUR Boot Camp, this past July in Chicago. We go over part of that talk in this show.

    Jessica and Abby are highly experienced appeals attorneys, with hundreds of ALJ hearings under their belts, even some before Judge Soltis. He has always been impressed with their preparedness and argument. Come find out why!

    What is a pre-hearing like and what to expect if you get one.

     

  • Tricky issues, such as:
    • multiple contractor participation,
    • when the patient checks out AMA,
    • when a nurse signs the order to admit.

PLUS

  • 2MN issues – can we prepare now for when these finally do come up?

Watch the replay and get our handouts, below…

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