Bob Soltis: Former ALJ tells all
CLEVELAND – Spoken like a true lawyer, Bob Soltis’ advice for HME providers working claims through the Medicare appeals process: be brief and be concise.
Soltis, a former administrative law judge and the author of the recently published book “How to Handle Your Medicare Hearing,” spoke to HME News in the wake of the Department of Health and Human Services’ proposed changes to the appeals system, an attempt to reduce a massive backlog at the ALJ level.
HME News: How can providers be brief and concise during their ALJ hearings?
Bob Soltis: Stick to the issue. If an ALJ asks you to propose a decision, do that rather than go on and on about how the beneficiary has a right to the equipment. No one is arguing about that; where’s the documentation to support it? Forget briefs; just give them one or two pages about what they should find and why they should find it.
HME: How would you fix the badly broken Medicare appeals system?
Soltis: There are two things that could help solve the problem. The AFIRM Act before Congress calls for 119 more ALJ teams. That would double the number of existing teams. A team is an ALJ, two staff attorneys, assistants. We need more people with buckets to bail water, and this would lower the level of the water significantly.
HME: The second item?
Soltis: Better training for the ALJs. And it needs to be independent training, not just from CMS. That’s just indoctrination. It’s important to know the rules, but you need to bring in training from outside, too.
HME: In your previous book “Hurry Up and Wait: Our Broken Medicare Appeal System” you don’t write very favorably of the RACs.
Soltis: The Office of Medicare Hearings and Appeals is comprised of employees who have taken an oath to give the government an honest day’s work for an honest day’s pay. There are no such requirements for these contractors. If an HME provider has to wait three years to get paid, why do the contractors get paid in advance, when their work hasn’t been completely reviewed by the people who have oversight? Why should the RACs get preferential treatment over the appellant, the provider? When Truman and Johnson came up with Medicare, it was for the beneficiaries; those are the people who should be getting preferential treatment. We’re shoveling providers to the back of the line, while the contractors are getting the money.