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Session spotlight: Be prepared for your day in court

Session spotlight: Be prepared for your day in court

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 lot of providers decide to handle these hearings without counsel or consultant. It's often a financial decision. The problem is, they don't know how the proceedings work.

HME:How can providers make the most of their time at these brief hearings?

Burris: Theydefinitely need to be prepared. They need to understand their documentation and the basis for the denial. They also need to know how they're going to respond because these hearings happen very quickly. The judges don't have a lot of time, so providers need to be ready to get out their important points about why the claims should be paid

HME:What are the pitfalls of these hearings?

Burris: Peoplearen't preparing at the early stages of the appeal process with a mind toward an ALJ hearing. They've probably handled the first couple stages on their own, so they don't have the necessary documentation. But by the time it gets to the ALJ it's too late. They need to think of it as an audit and get a plan early.

HME:Aren't providers often successful during ALJ hearings? Why?

Burris:More than half of providers are successful, and the fact is the prepared provider is going to have a much better track record.

HME:If attendees take away one thing from this session, what should it be?

Burris:Because of the hearing backlog being almost two full years at the ALJ level, people are waiting a long time to get their day in court. They must be prepared to have all their documentation, and have everybody lined up if they're going to have physicians or nurses testify.

Ross Burris, attorney, Polsinelli; Ray Lindholm, attorney, Polsinelli;

Stephanie Greene, president, Morgan Greene Consulting, LLC

“What Really Happens In An ALJ Hearing?”

Wednesday, Oct. 25, 9:00 AM - 10:30 AM, Room C204

Contact: Ross Burris, [email protected], 404-253-6010


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