When Jillian Longo joined The Audit Team in October, she brought with her insider knowledge from her previous role as an attorney adviser to administrative law judges (ALJs) with the Office of Medicare Hearings and Appeals. She recently gave HME News the scoop on what happens at the last level of appeals.
HME News: How has your experience working as an attorney adviser to the ALJs given you a different perspective?
Jillian Longo: I have a pretty good understanding of how the appeals system is working, how it’s going through the contractors and then, once it gets to the ALJ, what kind of mindset the ALJs are in right now. The docket is packed and it’s just growing—while I was there I saw a 100% increase in appeals.
HME: What’s causing the surge at the ALJ level?
Longo: It is finally hitting DME providers that they have to take it to that level, because if they don’t, they’re losing a lot of cash. At the ALJ level, you can organize your issues and your thoughts and present them to a real person who can understand where you’re coming from.
HME: Are you surprised by what you’re seeing now that you’re on the other side of things?
Longo: I was seeing the same problems there that our clients are facing right now. Not enough details in the written orders, lack of documentation of medical necessity—it’s the same across the board.
HME: What should providers do to succeed at an ALJ hearing?
Longo: Make sure you’re sending the right person to your hearing. Often, DME providers will have their billing manager do the hearing with the ALJ. That’s perfectly fine if you were denied for a billing reason, but a lot of times they can’t explain what the medical necessity is, why the patient needs that equipment, and a lot of ALJs want to hear that.