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ALJ backlog

DMEPOS appeals pile up

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10/19/2017

WASHINGTON – DMEPOS appeals at the Administrative Law Judge level make up about 49% of total appeals in FY 2017, consistent with the two previous years, according to a bulletin from AAHomecare.

In brief: Access survey slams bid program, CMS withdraws O&P rule

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10/13/2017

WASHINGTON – More than 60% of case managers report an increase in the number of Medicare beneficiaries who have developed medical complications, received emergency care or were readmitted to a hospital due to issues related to obtaining proper and/or timely access to DME,

ALJ wait time nears three years

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10/12/2017

WASHINGTON – The average wait time to get a hearing before an Administrative Law Judge is 1,082 days, a 41-day increase from earlier this year and a 205-day increase since last year, according to AAHomecare. The overturn rate at the ALJ is 28.3%.

Appeals backlog wears on

‘Hopefully we’re still in business when our cases get to a judge,’ says provider Donna Barraclough
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05/19/2017

YARMOUTH, Maine – A whopping 92% of respondents to a recent HME Newspoll say they have claims stuck at the administrative law judge level and are waiting—and waiting—for hearing dates.

In brief: CMS solicits input on reimbursement, nat’l RAC ready to roll

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03/10/2017

WASHINGTON – CMS has scheduled a call to solicit stakeholder input on its methodology for using information from the competitive bidding program for adjusting Medicare fee schedule amounts in non-bid areas.

HHS still says it can’t meet appeals deadline

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03/09/2017

WASHINGTON – The Department of Health and Human Services says it won’t meet a deadline to clear a backlog of appeals unless it settles the claims without seeing if they have merit.

Bob Soltis: Former ALJ tells all

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09/23/2016

CLEVELAND – Spoken like a true lawyer, Bob Soltis’ advice for HME providers working claims through the Medicare appeals process: be brief and be concise.

Q&A: Bob Soltis

Former ALJ tells all
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07/29/2016

CLEVELAND – Spoken like a true lawyer, Bob Soltis’ advice for HME providers working claims through the Medicare appeals process: be brief and be concise.

ALJ wait time increases

OMHA, C2C pick away at backlog, but still no ‘broad relief’
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05/27/2016

WASHINGTON – The wait time for an Administrative Law Judge hearing keeps growing—a symptom of ongoing problems with the audit process, say industry attorneys.

Not so QIC

C2C launches demo to resolve claims at the second level of appeals, before they escalate to the ALJ
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03/11/2016

JACKSONVILLE, Fla. – Certain HME providers will now have a voice at Medicare’s second level of appeals as part of a new demonstration project.

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