Tag Archives: alj

CMS to Temporarily Halt RAC Audits to Transition to New Contracts

After receiving pressure from more than 111 individual members of congress about the over aggressive nature of CMS’ RAC audit program, CMS announced earlier this week that they will temporarily halt new RAC audit requests to allow existing contracts with … Continue reading

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ALJ Forum Light on Relief, Stakeholders Voice Frustrations

The Office of Medicare Hearings and Appeals held a forum today in Washington DC on the recently disclosed 460k Administrative Law Judge (ALJ) appealed claims backlog. Chief ALJ Nancy Griswold headlined a day long event which featured updates from OMHA … Continue reading

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OPGA to Attend Medicare Audits Hearings & Appeals Forum, Seeks Stories

The recent memorandum sent to Medicare appellant from Chief Administrative Law Judge Nancy Griswold detailing the incredible appeals backlog, and subsequent decision to suspend assigning dates for new ALJ hearings for the next 24 months, has created a fervor of … Continue reading

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Group Representing RAC’s Blasts ALJ Delays, Seeks Reform

Add the Medicare contractors lobby to the growing chorus of stakeholders calling for reforms to the current Medicare appeals process, specifically the recently announced delays to Administrative Law Judge (ALJ) level appeals. The American Coalition for Healthcare Claims Integrity (ACHCI), which represents Medicare contractors, … Continue reading

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Chief ALJ Details 460k Appeals Backlog, Suspension of Hearings

A recently obtained memorandum from the Office of Medicare Hearings and Appeals (OMHA) Chief Administrative Law Judge Nancy Griswold to Medicare providers awaiting multiple Administrative Law Judge appeal hearings details the exponential growth in appeals to Medicare audits. The letter provides the most … Continue reading

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OIG: ALJ’s Overturn 56% of Provider Generated Appeals to QIC Audits

The HHS Office of Inspector General earlier this month released a report which studied the shockingly high overturn rate of provider generated appeals to private contract auditors employed by CMS to the Administrative Law Judge level.  The OIG found that 56% … Continue reading

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