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Hospice › Administrative Law Judge (ALJ)

Husch Blackwell LLP

Hospice Insights Podcast - Controlling the Narrative: A New Tactic for Auditors and ALJs

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Hospices that have gone through audits are familiar with certain recurring reasons why auditors deny claims. Two common reasons are the lack of support for a six-month prognosis and the insufficiency of the physician...more

Arnall Golden Gregory LLP

AGG Talks: Home Health & Hospice - Lessons Learned From ALJ Hospice Audit Appeals

Arnall Golden Gregory LLP on

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring is joined by Megan Turby and Lisa Barker, MD, of Gulfside Healthcare Services in Land O' Lakes, Florida. AGG represented Gulfside in a series of hospice...more

Morgan Lewis - Health Law Scan

Hospice Alert: Making Sense of New OMHA Administrative Law Judges

Morgan Lewis - Health Law Scan on

If your organization has faced a Medicare audit in the last decade, you may have experienced a significant delay in the Medicare appeals process due to a monumental backlog of claims pending in front of administrative law...more

Husch Blackwell LLP

After ALJ: Options and Opportunities in the Face of an Unfavorable ALJ Decision

Husch Blackwell LLP on

In the five-step audit appeals process, hospices often stop their appeal efforts after finding success at the third step, a hearing before an administrative law judge (ALJ). However, if an ALJ issues an unfavorable decision,...more

Husch Blackwell LLP

Hospice Audit Series | Welcome to the Party: Contractor Participation at ALJ Hearings

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Recently, there has been an uptick in contractor participation at the ALJ stage of hospice audit appeals. This development poses unique challenges and new advocacy opportunities for providers. In this episode, Husch...more

Husch Blackwell LLP

Hospice Audit Series: Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part II

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In Part II of our two-part series on ALJ hearings, Husch Blackwell’s Meg Pekarske unpacks strategies for winning with colleagues Bryan Nowicki, Emily Solum and Erin Burns. They explore what it means to be well-prepared and...more

Husch Blackwell LLP

Hospice Audit Series: Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part I

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In this two-part series, Husch Blackwell’s Meg Pekarske unpacks strategies for winning at ALJ hearings with colleagues Bryan Nowicki, Emily Solum and Erin Burns. They explore what it means to be well-prepared and who should...more

Husch Blackwell LLP

Hospice Audit Series: How are Hospices Faring at ALJ Hearings?

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After waiting years, hospices are getting their “day in court.” How are hospices faring? In this episode, Husch Blackwell’s Meg Pekarske is joined by colleagues Bryan Nowicki and Emily Park, who share insights on what it...more

Morgan Lewis - Health Law Scan

Telephone Hearing Demonstration at the Reconsideration Level: Now Open to Home Health and Hospice

Morgan Lewis - Health Law Scan on

Continuing to look for ways to reduce the Medicare administrative law judge (ALJ) appeals backlog, CMS has explored enhancing the role of Qualified Independent Contractors (QICs) to resolve disputed claims earlier in the...more

Sheppard Mullin Richter & Hampton LLP

Hospice False Claims: AseraCare Lost A Battle But Has Helped Win The War

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Last week, the 11th Circuit Federal Court of Appeals reversed summary judgment given to AseraCare in its hospice false claims case, setting up more litigation on the question whether AseraCare’s certifications were made in...more

Arnall Golden Gregory LLP

AGG Helps Hospice Weather the Perfect Storm of Aggressive Medicare Payment Denials and Administrative Appeal Backlog

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Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with a severe backlog of cases in queue for hearing before an Administrative Law Judge...more

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