Tag: Administrative Law Judge

When we included a Q&A with Josh Britten in our HME Newswire in February, I wasn’t surprised it resonated with readers. Britten, CEO of BritKare Home Medical, shared his battle to get back nearly $650,000 in denied Medicare claims – a battle that took him six years and more than $100,000 in legal and consultant fees. One provider responded to the story on Twitter by writing: “When you incentivize claims denial as a means of revenue generation you will find reasons to deny...

WASHINGTON – The Office of Medicare Hearing and Appeals (OMHA) has shared with AAHomecare that there were 201,292 appeals in the ALJ backlog at the end of 2020, about 85,000 of which involved DME. That’s a significant drop from 2019, the association says, when there were 318,000 appeals in the ALJ backlog, about 173,000 of which involved DME. In past years, DME appeals have represented up to 55% of the ALJ backlog, AAHomecare says.

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.The largest majority of poll respondents (28%) say their claims are going on three years old.“This is a major cash flow problem,” wrote Mary Klavoon of Buffalo Wheelchair in Buffalo, N.Y. “We buy and pay for equipment, and dispense to our qualified Medicare recipients, only to have to wait...

WASHINGTON - The wait time for an Administrative Law Judge hearing keeps growing—a symptom of ongoing problems with the audit process, say industry attorneys.“I don't think the problem lies in appeals,” said Ross Burris, an attorney in the Atlanta office of Polsinelli. “The problem lies lower down, either with audits that are too broad, or MACs that are just rubberstamping what the audit contractors are doing.”In the first quarter of 2016, the wait was 796 days. By the...

YARMOUTH, Maine - Long delays have made appealing denied claims a painful process for HME providers, forcing them to wait sometimes years for payment.Nearly all of the 120 respondents to the December HME NewsPoll (91%) say they have one or more appeals awaiting a hearing with an administrative law judge (ALJ), the third level of appeal. Forty-one percent of respondents say they've already been waiting at least a year.“Many of these claims are showing up as open invoices on our books and presenting...