Tag Archives: medicare appeals

Proposal to reduce Medicare appeals backlog won’t solve problem

In a letter to HHS’ Office of Medicare Hearings and Appeals, the American Hospital Association said HHS’ recent proposal to reduce the Medicare appeals backlog at the administrative law judge level is likely “to do little more than scratch the … Continue reading

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Medicare’s Efforts To Curb Backlog Of Appeals Not Sufficient, GAO Reports

By Susan Jaffe  | June 10, 2016 | Original post at Kaiser Health News Republished by permission. Despite interventions by Medicare officials, the number of appeals from health care providers and patients challenging denied claims continues to spiral, increasing the … Continue reading

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Via: Medicare Appeals Delay Case Moves Forward

As many hospitals, as well as other health care providers and suppliers with pending requests for ALJ hearing are acutely aware, lengthy adjudication delays exist within the Medicare appeals process. These delays are most significant at the third level of … Continue reading

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CMS Settles 300,000 Hospital Appeals

$1.3 Billion Paid to Providers The Centers for Medicare & Medicaid Services (CMS) has settled almost 300,000 appeals with over 1,900 hospitals under the Hospital Appeals Settlement, formerly known as the CMS Global Settlement Offer for Existing Appeals of Inpatient … Continue reading

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Senate Finance Committee Readies Bill to Improve Medicare Audit & Appeals Process

Senator Hatch Announces Markup of Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) bring their new bipartisan bill, the Audit & Appeal Fairness, Integrity, and Reforms in Medicare … Continue reading

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“Finally Friday!” Short-Stay DRGs & Pay-to-Appeal

FRIDAY May 1, 2015: Short-Stay DRGs & Pay-to-Appeal: What to expect and when Get the Handouts Day Egusquiza, a passionate and in-demand speaker and educator, told me last week that she thought the plans for a Short-Stay DRG were not … Continue reading

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U.S. Senate Committee blames providers for appeals backlog

Forget the denials, reduce the appeals The U.S. Senate Finance Committee heard testimony and expressed dismay yesterday about the humongous backlog of appeals at the Office of Medicare Hearings and Appeals (OMHA), now totaling over 870,000 appeals, according to testimony … Continue reading

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“Finally Friday!” Strategies for Medicare Level 3 Appeals

FRIDAY October 17, 2014 Medicare Appeals at Level 3: Providers Left in the Lurch Veteran Appeals Attorneys Review Recent Experiences with ALJs How Can You Prepare & Respond? Watch the Replay and Get the Handouts Since CMS began re-educating the … Continue reading

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CMS Report Reveals 77% of Appealed RAC Denials Are Improper

Figures Show 55% of RAC Denials Are Improper If you read my previous article and then read the CMS Report to Congress for the RAC Program in FY2013, you can find figures that tell the story in the title of … Continue reading

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“Finally Friday!” CMS OMHA Settlement Conferences and Statistical Sampling

OMHA Settlement Conferences and OMHA Statistical Sampling Alternate but Rejected Title for this Show: How CMS Plans to Use Your Money to Solve Their Problems We were joined this week by Jessica Gustafson and Abby Pendleton from The Health Law … Continue reading

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