Skip to main content
Keeping you afloat amidst the rising sea of regulations

Medicare Appeals at a Standstill: Providers Convene, Press CMS to Intervene

A December 31 memo from Nancy Griswold, Chief Administrative Law Judge (ALJ) of the Office of Medicare Hearings and Appeals (OMHA), delivered bad news to health care providers and suppliers awaiting resolution of long-standing health care appeals. The news confirmed what many who have waited years to have their cases heard had suspected — that OMHA is buckling under the backlog of 357,000 appeals awaiting adjudication by 64 ALJs across its four regional offices.

Michalski v. Scripps Mercy Hospital: A Win for Both Peer Reviewers and Hospital Boards

Earlier this month, Arent Fox Health Care partner Lowell C. Brown  published an article in California Healthcare News that provides insight into a key peer review case involving legal principles and individual behaviors that provide critical lessons for hospitals.

RAC Audits are Becoming Increasingly Frequent and Costly to Hospitals but Appeals can Succeed

The latest report published by the American Hospital Association (AHA) detailing the results of its RAC Trac survey1 reveals that RAC activity in hospitals has significantly increased in 2013. Not surprisingly, the financial impact of this increased RAC activity has grown substantially as well, both in terms of claims denials and the costs associated with responding to the RACs.