Skip to Content

Tag: Appeal


Viemed prevails in ALJ appeal, Medicare returns money

Specialty Providers

Viemed prevails in ALJ appeal, Medicare returns money

January 23, 2023HME News Staff

AFAYETTE, La. – An Administrative Law Judge has ruled in favor of Viemed Healthcare, overturning all remaining disputed claims for equipment services, related to findings from the Office of Inspector General.   As a result, Medicare Administrative Contractors returned 100% of the previously remitted funds to Viemed.  “We are extremely pleased with the judge’s decision in this matter, which reaffirms the high integrity of our clinical protocols and sets the record...

Administrative Law Judge (ALJ), Appeal, Casey Hoyt, Home ventilators, Viemed Healthcare


Read Full Articlered right arrow icon

Viemed balances business, wins at QIC level 

Specialty Providers

Viemed balances business, wins at QIC level 

May 20, 2022Theresa Flaherty, Managing Editor

LAFAYETTE, La. – Viemed’s latest growth figures signal that business is returning to something close to normal, company execs said during a recent call to discuss first quarter financial results for 2022.  The company reported core net revenues increased 18% compared to the same period last year.  “To sum up the overall theme of the first quarter, I would say execution, fueled by demand, driven by return-to-normal course of business,” said CEO Casey Hoyt.  Viemed...

Appeal, Financial Results, Qualified Independent Contractor, Viemed Healthcare


Read Full Articlered right arrow icon

News

Provider vindicated but wary

February 25, 2022Liz Beaulieu, Editor

AMARILLO, Texas – Provider Josh Britten appealed $650,000 worth of denied Medicare claims back in 2015 and it took him six years and more than $100,000 to get it back. And he’s one of the lucky ones – he had the resources to stick with it.  “We filed our third appeal in 2015 and we finally received a decision in 2021,” said Britten, CEO of BritKare Home Medical. “We were six years waiting on a decision (at the ALJ level) that should have taken 90 days.”  Here’s...

Administrative Law Judge (ALJ), Appeal, BritKare, Home Medical Equipment (HME), Josh Britten


Read Full Articlered right arrow icon

Andrea Stark

News

Andrea Stark makes case for making demo permanent

September 10, 2021Liz Beaulieu, Editor

YARMOUTH, Maine – The contract may be running out for a demonstration that allows HME providers to try to resolve denied claims by phone, but Andrea Stark says, “We’re onto something here,” and hopes CMS will make it a permanent part of the statement of work for the QIC.  The QIC, which is run by Maximus, recently announced it is winding down the demo per a contract that ends Dec. 31, 2021.  “Clearly, DME is complicated and suppliers feel better when...

Andrea Stark, Appeal, Home Medical Equipment (HME), QIC


Read Full Articlered right arrow icon

Also Noted

OMHA reduces ALJ backlog

November 19, 2020HME News Staff

WASHINGTON - The Office of Medicare Hearings and Appeals is back to operating at full capacity and is making its way through a backlog of appeals at the Administrative Law Judge level, AAHomecare reports. As of Oct. 31, 2020, there are about 85,000 DMEPOS appeals pending at the ALJ, a decrease of 51% compared to nearly 173,000 in 2019. OMHA also reported that the average wait time for an ALJ hearing is still four years, but it believes that should decrease as judges work their way through the backlog....

Administrative Law Judge (ALJ), Appeal, OMHA


Read Full Articlered right arrow icon

News

Q&A: Atty Matthew Fischer on appeals

October 28, 2019Liz Beaulieu, Editor

MIAMI - Matthew Fischer, a former senior attorney adviser for the Office Medicare Hearings and Appeals, has seen the ugliness of the appeals backlog from the inside. Here's what Fischer, now an attorney with the Zumpano Patricios, had to say about how to work a flawed system. HME News: What did the appeals system look like from the inside? Matthew Fischer: When I got there in 2011, I'd be looking at cases from two or three years ago. I thought, what is going on? They just didn't...

Administrative Law Judge (ALJ), Appeal, Matthew Fischer


Read Full Articlered right arrow icon

News

HHS reports 25% reduction in appeals backlog

October 16, 2019HME News Staff

WASHINGTON - The Department of Health and Human Services has reduced the backlog of Medicare appeals at the administrative law judge level by 25% through June 30, according to a status report provided to a federal court and obtained by the American Hospital Association. The status report is part of a federal court ruling last year that established annual deadline-based targets for reducing the backlog of Medicare appeals at the ALJ level. From Nov. 1, 2018, through the end of the third quarter...

Administrative Law Judge (ALJ), American Hospital Association (AHA), Appeal, OMHA


Read Full Articlered right arrow icon

News

CMS expands phone demo

October 23, 2018HME News Staff

JACKSONVILLE, Fla. - CMS will expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases to jurisdictions A and B on Nov. 1. The agency cited “strong support from the supplier community and the initial success of the demonstration” as reasons to expand the phone demo. “Effective on or after Nov. 1, the DME QIC will offer telephone discussions and/or re-openings to DME suppliers within the DME...

Administrative Law Judge (ALJ), Appeal, C2C Innovative Solutions, Phone demo, QIC


Read Full Articlered right arrow icon

News

Lack of unified stance on settlements, poll finds

October 12, 2018Liz Beaulieu, Editor

YARMOUTH, Maine - It turns out, even with the huge backlog of Medicare appeals stuck at the administrative law judge level, whether or not to accept a settlement is as divisive an issue as it gets in the HME industry. The respondents to a recent HME Newspoll were evenly divided on the issue, with 50% feeling the need to take a stand and 50% feeling the need to take the money and run. “Why should CMS be left off the hook and rewarded for messing things up in the first place?” wrote...

AAHomecare, Administrative Law Judge (ALJ), Appeal, Home Medical Equipment (HME)


Read Full Articlered right arrow icon

Also Noted

Regulatory updates: Low volume appeals, prior auths

April 5, 2018HME News Staff

CMS will be accepting expressions of interest for low volume appeals from April 12-June 8, 2018, for all NPIs. An EOI must be submitted for each NPI. The appeals are only offered to appellants that have less than 500 appeals sitting at OMHA and/or the Medicare Appeals Council as of Nov. 3, 2017, and each appeal must have a total billed amount of $9,000 or less. More information can be found here�CMS has removed the following items from the prior authorization Master List: hospital bed semi-electric...

Appeal, Home Medical Equipment (HME)


Read Full Articlered right arrow icon