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Tag: Backlog


News

Court agrees broken appeals systems is unfair

June 22, 2018Liz Beaulieu, Editor

DALLAS - A U.S. District Court's recent opinion prohibiting CMS from recouping alleged overpayments from a provider going through the appeals process until after the administrative law judge level sends a strong message, industry stakeholders say.As part of the June 4 opinion, Judge Ed Kinkeade of the U.S. District Court for the Northern District of Texas agreed to issue a temporary restraining order against CMS, the latest development in Family Rehabilitation, Inc. vs. Azar.“The system, which...

ALJ, Appeals, Backlog, Medicare, temporary restraining order


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Guest Blog

Judge getting impatient with HHS over massive ALJ backlog

April 6, 2018HME News Staff

I recently wrote an article entitled "Court Says No Recoupment Until After ALJ Hearings."  This article was about a court decision in which the judge said that recoupment of an extrapolated overpayment as a result of a ZPIC audit could not begin until after ALJ hearings were held. This article is reprinted below in italics. Now comes potentially additional good news! As you may recall, the American Hospital Association (AHA) and others sued the U.S. Department of Health and Human Services...

ALJ, Audits, Backlog


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News

HHS details status of appeals backlog

November 29, 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, Appeals, Backlog, OMHA


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Also Noted

Court pressures HHS over audit backlog

September 22, 2016HME News Staff

WASHINGTON - A federal court has ordered the U.S. Department of Health and Human Services to solve the backlog at the Administrative Law Judge level, according to an update from The VGM Group. In a decision handed down Sept. 19, the court denied HHS's request to put litigation with the American Hospital Association on hold until Sept. 30, 2017. “Between fiscal years 2010 and 2014, the number of appeals filed at step three grew 936%, from 41,733 to 423,534,” noted the D.C. court. “Because...

AHA, ALJ, Backlog


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News

HHS tries to chip away at appeals backlog

July 1, 2016Liz Beaulieu, Editor

WASHINGTON - The U.S. Department of Health and Human Services on June 28 outlined a number of proposed changes to the Medicare claims appeals process that it believes will help diminish a huge backlog.Among the changes HHS seeks to make: to allow certain decisions made by the Medicare Appeals Council, the highest level of appeal, to set precedent for lower levels, a move that will eliminate redundancy and resolve inconsistencies in the interpretation of policies, Nancy Griswold, chief law judge of...

Appeals, Backlog


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HHS proposes changes to appeal process

June 30, 2016HME News Staff

WASHINGTON - The U.S. Department of Health and Human Services on June 28 issued a notice of proposed rulemaking on changes to the Medicare claims appeal process.In the NPRM, HHS proposes additional administrative action to:. expand the pool of available adjudicators with the Office of Medicare Hearings and Appeals;. increase decision-making consistency among the levels of appeal;. and improve efficiency by streamlining the appeals process so less time is spent by adjudicators and parties on repetitive...

Appeals, Backlog


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OMHA to expand settlement process for appeals

September 22, 2015HME News Staff

WASHINGTON - The Office of Medicare Hearings and Appeals will expand a pilot project that it launched last year that seeks to settle appeals that are stuck at the administrative law judge level.OMHA has announced that it will hold a conference call on Oct. 15 to discuss its plans to expand its Settlement Conference Facilitation pilot project.The office did not provide details on how it plans to expand the pilot project, but it stated: “The teleconference will brief appellants on how they can...

Appeals, Backlog, OMHA, settlement


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Providers can now look up status of appeals

March 3, 2015HME News Staff

WASHINGTON - The Office of Medicare Hearings and Appeals has launched a new tool that allows providers to check the status of appeals at the administrative law judge level, AAHomecare reported this week.Providers can access the tool, called the ALJ Appeal Status Information System, by going to OMHA's website, www.hhs.gov/omha, and selecting the “Appeal Status Lookup” link from the navigation bar on the left side.“We applaud OMHA for taking this step to allow suppliers to see what...

Appeals, Audits, Backlog, status


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On the Editor's Desk

Would you drop an appeal for partial payment?

September 2, 2014Liz Beaulieu, Editor

We're used to CMS breaking news late on the Friday before a long holiday weekend. And Friday, Aug. 29, was no exception. (It turns out Invacare took a page from CMS's playbook and also announced late on Friday that it was selling Altimate Medical to strengthen its balance sheet and reduce debt.) At about 3:20 p.m. EST, CMS sent out an “MLN Connects Provider eNews - Special Edition” offering a settlement to acute care hospitals and critical care hospitals to resolve appeals of patient...

Audits, Backlog, settlements


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News

Audits: 'We are in crisis,' stakeholders say

February 14, 2014Theresa Flaherty, Managing Editor

WASHINGTON - HME stakeholders made their case against an audit program run amok at a forum last week.“We need to have a resolution on how to help my providers today because we are in crisis,” said Tom Ryan, president and CEO of AAHomecare, who attended the daylong event on Feb. 12. “The system is broken and it needs to be fixed.”The Office of Medicare Hearings and Appeals (OMHA) hosted the forum to discuss an increased workload that has led to a backlog of 460,000 appeals...

Appeals, Backlog, Denials, Forum


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