Responses to After the ALJ???
Amanda Springer
Description
Collection
Title:
Responses to After the ALJ???
Creator:
Amanda Springer
Date:
4/11/2013
Text:
Thank you to all who have responded. As far as assessing fees to the claims I tend to believe the response that it is possible. I used to work as a court clerk and we would see that request all of the time. I do know that in a civil case you are able to request fees and legal fees be recouped if you win your case so I don’t see why it would be any different here. I will be going back on ALL of my claims and making this request (even this late in the game) immediately. The worst they can say is No….
Original Questions:
To all who have successfully finished the ALJ process and had their cases overturned (Congratulations!)
1.) Once you have received your notification that you were successful what’s the next step?
2.) How long until your monies have been paid back by Medicare?
3.) Have any of you charged administrative fees, interest and/or legal fees? If so, how did you notify them that you would do this and how did you calculate such fees?
RESPONSES:
We have had success with the ALJ several times; usually it takes at least 90 days to see your payment returned once they've issued a decision. We had to call the Noridian customer service line several times to make sure they had received the appeal information from the ALJ and were going to refund the money back to us. It took them a couple of months, but they did refund us. As far as interest, etc..., they will automatically calculate & pay interest to you. We recouped $60,000 on a prosthetic at the ALJ level and were paid back over $7,100 in interest alone by Medicare. At this point, as far as hearing turnaround times, they are battling extreme backlog. We are still waiting for hearings to be scheduled on appeals that we submitted to the ALJ over 9 months ago. The waiting process can definitely be lengthy for a hearing and from what we've been told by various ALJ personnel, there is no specific timeline that they're required to follow. The longest ALJ process that we've experienced thus far from filing through receiving the decision letter was approximately 18 months.
As far as I know interest will only be considered if you ask for it. Administrative time must be logged and a charge per page for printing can be requested, just like legal fees it must be itemized. This is something we just found out from our rep., but To be considered it must be requested.
The ALJ decision is forwarded to the DME MAC and payment will be issued. Routinely you can expect payment within a 45-60 day window. The most recent favorable decison we received was issued on October 24, 2012 and remittance notice was dated December 10, 2012. We have not attempted to collect additional fees. I would also add the wait time for a hearing to be scheduled is increasing significantly. I have a hearing scheduled for April 16 and the request was submitted on June 7, 2012. After first successful with the ALJ it took about two to three weeks for the monies to be received. They did not offer any interest or any other compensation for time in case. Whatever in all subsequent appeals we have been requesting interest in the same manner that Medicare charges us for over payments. We have not had any success yet but it's supposed to calculate. We just sent off to more claims to ALJ with this interest request. I have an example with dates/time frames for you:
Mailed ALJ Request on 5/4/12. I didn't hear anything so I finally called Medicare to find out how to follow up to see if they had actually received it. I was given an email address for Mr. Richard Day ( <Email Address Redacted> ). I emailed him on 8/31/12. I received an email back from him on 9/4/12 telling me the ALJ request had been received and he provided me with the assigned judge's name and address/phone number of OMHA Fiedl Office to follow up on the appeal. I think the next day I received a letter dated 8/28/12 telling me the ALJ Case Number and who the judge was. So it took over 90 days just for me to receive a letter stating that it was in process. On 9/6/12 I received the notice of a favorable decision. Payment was received on 10/2/12. So It took 4 months for me to hear that my ALJ case had been assigned and processed and it took approximately 30 days from the ALJ decision for me to receive payment from Medicare. But this DOS was 11/14/11 so it took me almost an entire year to get the claim paid. As far as billing for our time, administrative fees, etc. I do not think we are able to do that.
I have some information in regards to your questions.
1) nothing, they notify your Medicare provider and they take it from there.
2) usually 30 day's to get your funds, can be quicker if electronic remits.
3) We have not, nor am I aware of a process but would love it if someone has info on this.
As far as the ALJ, they are backed up nation wide. It was my understanding, from a phone call this past Friday, that regardless of your region, state, all appeals go to Ohio, they are then processed and assigned a judge that may or may not be in your area of the country. Once Ohio sends it on, it can take up to 6 months to get it going. It is not a speedy process, and we are all in agreement it is a pain and unnecessary, however, until they resolve this, we are where we are. As far as your November appeal, you can call them @855-556-8475 and they should be able to assist you with an update or status on your case.
Original Questions:
To all who have successfully finished the ALJ process and had their cases overturned (Congratulations!)
1.) Once you have received your notification that you were successful what’s the next step?
2.) How long until your monies have been paid back by Medicare?
3.) Have any of you charged administrative fees, interest and/or legal fees? If so, how did you notify them that you would do this and how did you calculate such fees?
RESPONSES:
We have had success with the ALJ several times; usually it takes at least 90 days to see your payment returned once they've issued a decision. We had to call the Noridian customer service line several times to make sure they had received the appeal information from the ALJ and were going to refund the money back to us. It took them a couple of months, but they did refund us. As far as interest, etc..., they will automatically calculate & pay interest to you. We recouped $60,000 on a prosthetic at the ALJ level and were paid back over $7,100 in interest alone by Medicare. At this point, as far as hearing turnaround times, they are battling extreme backlog. We are still waiting for hearings to be scheduled on appeals that we submitted to the ALJ over 9 months ago. The waiting process can definitely be lengthy for a hearing and from what we've been told by various ALJ personnel, there is no specific timeline that they're required to follow. The longest ALJ process that we've experienced thus far from filing through receiving the decision letter was approximately 18 months.
As far as I know interest will only be considered if you ask for it. Administrative time must be logged and a charge per page for printing can be requested, just like legal fees it must be itemized. This is something we just found out from our rep., but To be considered it must be requested.
The ALJ decision is forwarded to the DME MAC and payment will be issued. Routinely you can expect payment within a 45-60 day window. The most recent favorable decison we received was issued on October 24, 2012 and remittance notice was dated December 10, 2012. We have not attempted to collect additional fees. I would also add the wait time for a hearing to be scheduled is increasing significantly. I have a hearing scheduled for April 16 and the request was submitted on June 7, 2012. After first successful with the ALJ it took about two to three weeks for the monies to be received. They did not offer any interest or any other compensation for time in case. Whatever in all subsequent appeals we have been requesting interest in the same manner that Medicare charges us for over payments. We have not had any success yet but it's supposed to calculate. We just sent off to more claims to ALJ with this interest request. I have an example with dates/time frames for you:
Mailed ALJ Request on 5/4/12. I didn't hear anything so I finally called Medicare to find out how to follow up to see if they had actually received it. I was given an email address for Mr. Richard Day ( <Email Address Redacted> ). I emailed him on 8/31/12. I received an email back from him on 9/4/12 telling me the ALJ request had been received and he provided me with the assigned judge's name and address/phone number of OMHA Fiedl Office to follow up on the appeal. I think the next day I received a letter dated 8/28/12 telling me the ALJ Case Number and who the judge was. So it took over 90 days just for me to receive a letter stating that it was in process. On 9/6/12 I received the notice of a favorable decision. Payment was received on 10/2/12. So It took 4 months for me to hear that my ALJ case had been assigned and processed and it took approximately 30 days from the ALJ decision for me to receive payment from Medicare. But this DOS was 11/14/11 so it took me almost an entire year to get the claim paid. As far as billing for our time, administrative fees, etc. I do not think we are able to do that.
I have some information in regards to your questions.
1) nothing, they notify your Medicare provider and they take it from there.
2) usually 30 day's to get your funds, can be quicker if electronic remits.
3) We have not, nor am I aware of a process but would love it if someone has info on this.
As far as the ALJ, they are backed up nation wide. It was my understanding, from a phone call this past Friday, that regardless of your region, state, all appeals go to Ohio, they are then processed and assigned a judge that may or may not be in your area of the country. Once Ohio sends it on, it can take up to 6 months to get it going. It is not a speedy process, and we are all in agreement it is a pain and unnecessary, however, until they resolve this, we are where we are. As far as your November appeal, you can call them @855-556-8475 and they should be able to assist you with an update or status on your case.
Citation
Amanda Springer, “Responses to After the ALJ???,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/235036.
