So You Think You Know What “Wholly Favorable” Means…

Veteran attorney Drew Wachler discusses his handling of a few of these strange ALJ decisions…

For your convenience, the transcript of my portion of this video appears beneath the player. (Does not include interviews.)

Click the image below to start the video if it does not auto-start.



Hello everyone, I’m Ernie de los Santos, founder of Appeal Academy and author of INSIDE RAC SUMMIT, Insights and Highlights from the Seventh National RAC Summit. Thanks for stopping by for our new video and our fifth interview in this series.

Today I have once again recorded a short interview with Drew Wachler, a 25-year veteran healthcare attorney, talking about what has happened recently when he received some of these strange appeals decisions, where an Administrative Law Judge declined to comment on whether a claim qualified for inpatient status or not, claiming that the difference between inpatient and observation was merely a payment amount, and therefore not to be decided by an Administrative Law Judge.

I hope you have listened to the other videos and you have by now downloaded a complete copy of INSIDE RAC SUMMIT. I’ve been getting great comments and emails from people who have found my report helpful. I want to thank all of you who have written and commented, I very much appreciate your feedback, and I’m again glad it is helpful to you. As I’ve mentioned before, I’ve been trying to help people like all of you, over the past few years, and I’m so happy I’ve found what I think is the best way to get this kind of help and information out to you, in a very easy to use, effective and affordable manner.

Today I want to assure you that I will continue to provide this kind of information and even more, inside Appeal Academy. If you are finding this useful, there is even more available to you if you take advantage of what I have for you on the campus at  In fact, next time I talk to you, I’m going to tell you about some webinars that I just licensed for all the members at Appeal Academy. I’m really excited about these because they are from a highly respected statistician who is now working with me to create some tools that will help you in ways you have only been able to dream about. What if you could have a tool that looks at your data just like the auditors do.  And… Could tell you not only what you need to fix in your revenue cycle, but exactly where to go look to fix it?

I’ll have more about all of that at a later date, I’m really excited, can’t wait to tell you more. But let’s get back to what I have for you today….

Drew Wachler discusses his handling of a few of these strange alj decisions, including what he did after he got them, he talks about his conversation with the AdQIC, and with his contacts at CMS. We haven’t talked about this before, in this series — what is CMS thinking about all this, and I don’t want to steal his thunder, you need to listen to this whole thing, the interview itself is 10 minutes long, let’s start it now…


[interview goes here – please listen to the video above]


So there you have it, unfortunately, if you get one of these decisions, which frankly, to me, seems more and more likely, at least for the near future. You read the decision closely to see what you might be able to argue with the MAC and or the AdQIC, then you get ready to decide whether taking the claim to the next level is worth the trouble or not.

And by the way, I have an interview that I did with Mike Frith, the Regional Manager for Patient Accounts at Trinity Health-Saint Alphonsus, in Boise, Idaho. I called Mike to ask him how he would analyze these kind of appeals and decide their value – I asked because of the recent offers that ALJs have been making to hospitals to forego their hearings on appeals of denials for inpatient admissions and instead just accept outpatient payments, period. You might remember Mike from both the Regional and National RAC Summits from last year, when he offered his advice on how to analyze a hospital’s participation in the AB Rebill Project Demonstration.

So watch for my email, for Mike’s interview and a special offer for you so that you can continue to take advantage of all the great information we have for you inside Appeal Academy.

Until then, good luck with all your appeals.

I’m Ernie de los Santos, for Appeal Academy, thanks for watching.

Leave a Reply

Your email address will not be published. Required fields are marked *