HCAF: Writing Winning Appeals in the NEW ALJ Environment

Recent statistics show that something has changed at the Administrative Law Judge (ALJ) level. The overturn rate has drastically fallen over the past year. If you receive a denial of your claim-- how to meet the higher, more difficult standard that is being set? Now, more than ever, dealing with the Medicare appeals process can be confusing and frustrating. Gleaned from thousands of appeals and hundreds of hearings, we will address the appeal process, preparation, and presentation tips for ALJ hearings to push you towards success, including laying the groundwork during the entire Medicare appeals process to build toward a winning presentation. This also includes guidance on writing lower level appeals that both support payment at earlier levels and build a strong foundation for the hearing. For the ALJ hearing, it introduces procedural documents, administrative tasks prior to the hearing, how to prepare for the hearing, and presentation pointers to maximize the chance for a successful outcome. The appeals process is not an experience we wish to have, but home health agencies can put a positive spin on it as a staff development and learning opportunity.

Course Author: Joseph Osentoski, BAS, RN-BC