Andrew B. Wachler, Esq. Jessica C. Forster, Esq. On July 5, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule heralding significant changes to the Medicare appeals process, particularly in light of the backlog of Medicare appeals currently pending. Recently, this backlog has been the subject of focus for the U.S. Department of Health and Human Services (HHS), CMS, the Government Accountability Office (GAO), and Congress. These government entities …Read more
Last month the U.S. Department of Health and Human Services (HHS) issued a notice of proposed rulemaking known as HHS 2015-49. This proposed rule revises the procedures that HHS follows at the administrative law judge (ALJ) level of appeal and also revises the procedures that HHS follows at the lower levels of appeal – including the Departmental Appeals Board (DAB) level. This article discusses one of the proposed changes in particular: the …Read more
In 2010, there were 41,733 Medicare appeals filed with administrative law judges (ALJs). By 2015, the number had increased to 432,534, a jump of 936 percent. The number of ALJs handling this appeals load has remained more or less constant at 77. In 2010, the ALJ system (Level 3 appeals) already was showing symptoms of being overloaded. More than one-third (36.7 percent) of ALJ decisions were being turned in late, …Read more
Andrew Wachler, Esq. Steven Greenspan, JD, LLM With hopes that the Centers for Medicare & Medicaid Services (CMS) might reopen the 68-percent settlement solution it once offered providers to expedite the appeal process, RACmonitor is producing a special-edition broadcast on the topic scheduled to air live at noon ET on Tuesday, Aug. 9. The 60-minute, live “town hall” broadcast is being sponsored by...Read more
Some loyal RACmonitor readers may recall that way back in November of 2014, I wrote a RACmonitor article entitled It’s All About the Money – When is a Doctor Not a Doctor?, about Medicare Advantage (MA) plans contracting with firms to send physicians and non-physician practitioners out to the homes of their enrollees to take a history and perform a...Read more
In a recent article, I quoted Dave Mason to illustrate the point that it can be reasonable to question authority. At times, however, people make unreasonable challenges. An irrational employee is not only a huge frustration; they also present a major compliance risk. Many qui tam lawsuits being with an employee who mistakenly believe you are breaking the law but won’t...Read more
Question: How do you spell “rural regulatory relief?" Answer: By providing a permanent extension of the enforcement instruction on unreasonable supervision requirements for outpatient therapeutic services in critical access and small rural hospitals. In what some are seeing as a wrong being addressed – if not finally righted – and at perhaps one of the most vulnerable times for healthcare in rural...Read more
The data collection requirements for inpatient rehabilitation facilities (IRFs) continue to grow and there is NO relief in sight. This webcast will demonstrate and how potential opportunities could reduce the burden of this data collection.
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