Tag: ALJ Delay

WASHINGTON - The years-long delay in the appeals process at the administrative law judge level is costly for both providers and CMS, says a new report.More than half of claims are overturned on appeal and when they are, CMS must pay interest back to providers, according to the American Orthotic & Prosthetic Association, which commissioned the report.“This is a crisis that should never have happened,” said Charles Dankmeyer, president of AOPA. “We need to fix this in a way that saves...

WASHINGTON - The Office of Medicare Hearings and Appeals (OMHA) is seeking public input on current initiatives to deal with the increased workload and backlog of appeals at the Administrative Law Judge (ALJ) level, according to AAHomecare. In a notice published in the Nov. 5 Federal Register, OMHA asks, among other questions: Are there other suggestions for addressing the increased workload and/or backlog of appeals at the Administrative Law Judge level that comply with current statutory authorities...

WASHINGTON - The Office of Medicare Hearings and Appeals (OMHA) held a hearing last week on the ongoing backlog of audits and efforts to address the problem, but industry stakeholders who attended said it was extremely frustrating. “They seem to think the providers need to be educated on documentation,” said Seth Johnson, vice president of government relations for Pride Mobility. “The audit process is broken.” It was clear during the meeting that real-time, practical solutions...

WASHINGTON - A subcommittee hearing on audits yesterday shows that lawmakers are getting the message.“I have some serious concerns that the current system of post payment audits by recovery audit contractors (RACs) is resulting in a significant burden on some providers,” said Rep. Michelle Lujan Grisham, D-N.M., at a hearing held by the House Oversight and Government Reform Subcommittee on Energy Policy, Health Care and Entitlements, according to a bulleting from The VGM Group.Officials...

Mr. Watson's letter (“28-month delay will be disasterous for providers,” January 2014) was right on the money, no pun intended. It will be disastrous for providers, but the real loser here is the person who must live his or her life from the seat of a wheelchair. We have a number of clients who have rather complicated power wheelchairs. A number of the chairs were initially paid for, but Medicare has been retrieving money on those paid claims at...

These days, we are hard-pressed to find a provider who doesn't want to vent about audits. From massive recoupments to a two-year wait for an appeals hearing, the system, say providers, is broken.Right hand, meet left handNo sooner does provider Glenn Steinke respond to an audit, then he gets hit again—for the same claim.“Five days after we send the responses, we get a request for the same audit again,” said Steinke, owner of Airway Medical in Bishop, Calif. “We've also had...