Tag: Ross Burris
Settlement update: A non-option option for appeals
December 8, 2017Liz Beaulieu, Editor
WASHINGTON - CMS has rolled out a new settlement option for low-volume appeals, but it's not likely HME providers will take the agency up on its offer, stakeholders say.
Providerswith fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals and the Medicare Appeals Council combined as of Nov. 3, 2017 with a total billed amount of $9,000 or less per appeal could be eligible, if certain other conditions are met.
The kicker: CMS will settle eligible appeals at 62% of the...
Be prepared for your day before ALJ hearing
November 21, 2017Jeff Rowe
ATLANTA - Many HME providers end up in front of an administrative law judge (ALJ) to contest a reimbursement denial, but too often they don't know what they're up against.
At Medtrade in Atlanta, in “What Really Happens In An ALJ Hearing?” Ross Burris, an attorney with the Kansas City-based law firm Polisinelli, was part of a panel that walked attendees through how to prepare and manage an ALJ hearing.
HME News: Why is there a need for a session like this?
Ross Burris:...
Session spotlight: Be prepared for your day in court
October 24, 2017Jeff Rowe
ATLANTA - Many HME providers end up in front of an administrative law judge to contest a reimbursement denial, but too often they don't know what they're up against, says speaker Ross Burris.
In the session “What Really Happens In An ALJ Hearing?” today at Medtrade, Burris, an attorney with Polisinelli, will be part of a panel that will walk attendees through how to prepare and manage an ALJ hearing.
HME News:Why is there a need for a session like this?
Ross Burris:A...
Expect audits to get more aggressive
January 27, 2017Theresa Flaherty, Managing Editor
atlanta - When ZPIC auditors come calling, it's important not to throw up your hands in surrender because there's too much at stake, said healthcare attorney Ross Burris.
“They can suspend your payments; they can revoke your status,” said Burris, a shareholder with Polsinelli. “That six-month revocation can turn into 12 months. You'll be shocked at the aggressive nature and authority of some of these contractors.”
ZPIC audits are typically provider specific...
ALJ Appeals: Be prepared from the start
November 30, 2016R. Ross Burris
A. A supplier that disagrees with a Qualified Independent Contractor's reconsideration decision is entitled to a hearing before an administrative law judge. But, an ALJ will not review new evidence—evidence that was not presented during previous levels of appeal without the supplier presenting “good cause.” The ALJ will not review any new evidence unless that evidence was unavailable or unknown at the time of the determination.
Oftentimes, suppliers rely on the documentation...
ALJ Appeals: Pay attention to details
September 29, 2016R. Ross Burris
A. A home medical equipment supplier can protect its profit margins from recoupment by establishing a compliance culture that collects adequate documentation and submits proper billing claims, but it is equally important for a supplier's bottom line to defend and appeal erroneous Medicare recoupments.
Below are a few tips for defending claims from start to finish.
Help Your Attorney
Involving an attorney at the ADR letter stage is not always necessary, but a response that does...