Skip to Content

Tag: ALJ backlog


News

Stakeholders fear QIC switch

April 20, 2018Liz Beaulieu, Editor

YARMOUTH, Maine - Stakeholders are not happy that C2C Innovative Solutions appears to be losing its gig as the Qualified Independent Contractor for HME.Jacksonville, Fla.-based C2C has popularized a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases. In 2017, 64% of claims that were involved in the demo were found fully favorable and 3% were found partially favorable, AAHomecare recently reported.“C2C has been...

ALJ backlog, C2C Innovative Solutions, Qualified Independent Contractor


Read Full Articlered right arrow icon

Also Noted

Update: C2C phone demo

April 12, 2018HME News Staff

WASHINGTON - C2C Innovative Solutions, the QIC contractor, reopened 54,138 claims and withdrew 27,132 claims from the Administrative Law Judge backlog in 2017, according to a bulletin from AAHomecare. Of those who participated in the telephone demonstration, 64% of the claims were found fully favorable and 3% were found partially favorable. AAHomecare also reports that C2C has also lost their QIC contract, a decision it expects the contractor to appeal.

ALJ backlog, C2C Innovative Solutions, QIC demo


News

In brief: HHS details status of appeals backlog, supplier dropped from lawsuit

December 1, 2017HME News Staff

FALLS CHURCH, Va. - The Office of Medicare Hearings and Appeals receives more than a year's worth of appeals work every 24 weeks at the third level of appeals, according to a recent PDF posted to the agency's website.As of the end of the fourth quarter of fiscal year 2016, the pending workload at the administrative law judge level exceeded 650,000 appeals, while annual adjudication capacity going forward was about 92,000 appeals, according to the “HHS Primer: The Medicare Appeals Process.”At...

ALJ backlog, H.R. 4229, J&B Medical Supply, Medtrade Spring 2018, OMHA, Vertess


Read Full Articlered right arrow icon

Also Noted

DMEPOS appeals pile up

October 19, 2017HME News Staff

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. As of August 2017, the Office of Medicare Hearings & Appeals had 591,962 total appeals pending—an increase of 300% since 2016. The number of DMEPOS appeals as of Oct. 12 is 291,047.

ALJ backlog


News

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

October 13, 2017HME News Staff

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, according to a final report from Dobson DaVanzo & Associates.“(The competitive bidding program has) negatively affected beneficiaries' access to DME services and supplies, adversely impacted case managers' ability to coordinate...

aahomecare, ALJ backlog, case managers, Gary Sheehan, orthotics, permobil


Read Full Articlered right arrow icon

Also Noted

ALJ wait time nears three years

October 12, 2017HME News Staff

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%. The Office of Medicare Hearings and Appeals recently said it will no longer publish detailed workload information showing the breakdown of the number and type of appeals at the ALJ; however, it has offered to share DMEPOS-specific data with AAHomecare.

ALJ backlog, Medicare audits


Read Full Articlered right arrow icon

News

Appeals backlog wears on

May 19, 2017Liz Beaulieu, Editor

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...

Administrative Law Judge, ALJ backlog, appeals, audits


Read Full Articlered right arrow icon

News

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

March 10, 2017HME News Staff

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.The 21st Century Cures Act mandated that the agency solicit and take into account stakeholder input on future pricing in non-bid areas.The act also mandated that CMS take into account the highest amount bid by a winning supplier in a bid area, as well as make comparisons in bid and non-bid areas...

ALJ backlog, Performant, prior auths, Simon Margolis Fellow Award, SoClean


Read Full Articlered right arrow icon

News

HHS still says it can't meet appeals deadline

March 9, 2017HME News Staff

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.In a status report, HHS told the D.C. Circuit court that its 687,382-claims backlog is projected to reach more than 1 million by the end of fiscal year 2021, according to Law360. The agency made a similar claim in February, saying it needed more money and cooperation from the provider community.“Although the initiatives...

ALJ backlog


Read Full Articlered right arrow icon

News

Bob Soltis: Former ALJ tells all

September 23, 2016Liz Beaulieu, Editor

CLEVELAND - Spoken like a true lawyer, Bob Soltis' advice for HME providers working claims through the Medicare appeals process: be brief and be concise.Soltis, a former administrative law judge and the author of the recently published book “How to Handle Your Medicare Hearing,” spoke to HME News in the wake of the Department of Health and Human Services' proposed changes to the appeals system, an attempt to reduce a massive backlog at the ALJ level.HME News: How can providers be brief...

ALJ backlog, Bob Soltis, Medicare appeals


Read Full Articlered right arrow icon