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Claims Appeals Developments and Proposals for Expansion

August 11, 2016
1:00 PM - 2:00 PM

August 11, 2016
1:00 PM - 2:00 PM

Join us as we discuss developments and proposals for change in the Medicare appeals process meant to help reduce the backlog of more than 700,000 cases.

Centers for Medicare and Medicaid Services (CMS) has introduced a pilot alternate dispute resolution process designed to bring the appellant and CMS together to discuss the potential of a mutually agreeable resolution for claims appealed to the Administrative Law Judge (ALJ) hearing level of the Medicare Claim Appeals Process. The pilot has been in place for nearly two years and CMS is proposing to expand it to a broader range of dates of service and claims. This session will address the history of the process so far and give practical tips on participating in the pilot.

In addition, we will discuss major revisions to the Medicare Appeals Process proposed by CMS. The new proposals are designed to streamline the decision-making process and reduce the number of cases that go to the third level of appeals, where many cases linger waiting for a hearing and then a decision from an administrative law judge.

Some of the proposed changes include:

  • Designate Medical Appeals Council so decision makers at lower levels will have to follow
  • Allow senior attorneys, instead of ALJs, to handle some procedural matters for claims appeals
  • Eliminate some steps in the appeals process to simplify the system

Events Contact

Heather Stripling
T: 205.250.8332
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