Additional Information RAC/Overpayment Audits

Additional Information RAC/Overpayment Audits

Sara Beck

9/9/2013

A lot of you have asked me to provide the location of the provision of the Social Security Act which outlines the ALJ time frame of 90 days.  So, I figured I would post it for you all.  The citation is as follows: 42 U.S.C.A. §1395ff.  This entire sections pertains to Medicare Audits and Appeals, and is very helpful.  It outlines the rules and regulations that Medicare and its contractors must follow (or should follow) in the appeals process.  It's a great tool to use and I encourage you all to familiarize yourselves with this section. Specifically, the section that I noted in my previous post states the following:  an administrative law judge shall conduct and conclude a hearing on a decision of a qualified independent contractor under subsection (c) of this section and render a decision on such hearing by not later than the end of the 90 day period beginning on the date a request for a hearing has been timely filed. 
 
So, if the ALJ does not provide a decision within 90 days, you have the right to appeal to the Departmental Appeals Board.  This sections states: In the case of a failure by an administrative law judge to render a decision by the end of the period described in paragraph (1), the party requesting the hearing may request a review by the Departmental Appeals Board of the Department of Health and Human Services... 
 
In conclusion, keep appealing.  And keep close watch on those appeals.  As providers, we have rights and I suggest we utilize those rights to the fullest extent under the law. 
 
Please let me know if you have any questions, or if I can be of any assistance. 
 
Sara Beck
San Joaquin Orthotics & Prosthetics