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Tag: ALJs


Obscure court ruling could set powerful precedent

December 13, 2013Elizabeth Deprey

WASHINGTON - A 5th Circuit Court ruling over runny eggs could be just the ammunition HME providers need in cases involving ambiguous CMS guidelines.“People think this case is humorous because of the underlying facts, but it has implications for all types of Medicare providers,” said Edward Vishnevetsky, an associate with Munsch Hardt in Dallas. “This is the first time we've seen a court not defer to CMS's interpretations.”Prompting the ruling was an appeal filed by Elgin Nursing...

ALJs, CMS Guidelines, Denials, Edward Vishnevetsky, Local coverage determinations, Neil Caesar

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Appeals: Expect longer delays

November 22, 2013Theresa Flaherty, Managing Editor

WASHINGTON - It's gone from bad to worse for providers trying to get on the dockets of Administrative Law Judges (ALJs).That's because the Office of Medicare Hearings and Appeals (OMHA) recently posted a message saying it would defer assignments for the hearings for possibly as long as 28 months.“There's no end in sight and it's probably going to get worse,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “I think all of us need to put pressure on CMS to...

ALJs, Audit Appeals, Audits

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On the Editor's Desk

A program that's out of control (besides competitive bidding)

November 11, 2013Liz Beaulieu, Editor

Audits are as big an issue—if not bigger, for some providers—as competitive bidding. So the latest news from the Office of Medicare Hearings and Appeals (OMHA) that it will defer assignments for ALJ hearings possibly up to 28 months has put some providers right over the edge. And I don't blame them. For a story that will appear in our December issue, AAHomecare's Kim Brummett told Managing Editor Theresa Flaherty: “If CMS wants to continue this ferocious cycle of audits, they need...

ALJs, Appeals, Audits, Delays

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