Annual Update to Threshold Amounts for Medicare Appeals

The annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process has been updated. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on or after January 1, 2020. The calendar…

Data Shows Progress in Reducing Home Health and Hospice Appeals Backlogs at ALJ Level

  –Low reversal rate continues to trouble home health sector Medicare law requires that providers have a right to a hearing before and decision from an Administrative Law Judge (ALJ) within 90 days of request.  If the decision is not rendered consistent with that standard, the appellant can accelerate the appeal to the next level. …