Results for What should you expect at the ALJ Hearing?

Results for What should you expect at the ALJ Hearing?

Lana Nassan

6/10/2015

Thank you so much for all your responses! Just fantastic- I feel prepared!


 

WHAT SHOULD YOU EXPECT AT YOUR ALJ HEARING?

How the ALJ hearing will go, depends on the Judge. However, for the most
part, the hearing is fairly short, sweet and to the point. The judge will
first ask you to identify yourself and your title. Then he will let you
know who else is on the line from Noridian. He will swear you all in. Make
sure you have the date of service, patient name and L-codes in question, in
front of you, just in case.

 

Then, the judge will ask you to state your position. You will always go
first. Be prepared to present your case quickly and be concise. Another
helpful tool is to humanize the case. Talk about the patients family, his
day-to-day life and how helpful the services you provided were. I had one
appeal where I discussed how the patient used the prosthesis in question to
walk his daughter down the isle at her wedding. It helps to give the judge
an idea of what the prosthesis did and how it helped the patient.

 

The MD from Noridian will most likely be Barbara O'Neal. She is very hard
nosed and focuses only on Medicare rules. She can be very confrontational,
but if you stay calm, she will get flustered. My advice on how to handle her
is to ask her direct questions, as a licensed medical physician. She is an
MD and, by law, is required to put the patient's well being ahead of any
financial gain or influence. Ask her if she thinks the patient needed the
item you provided....ask her, in her medical opinion, if the services you
provided benefited the patient. Generally, if you ask the judge if you can
question Dr. O'Neal directly, he will allow it. Remember, Dr. O'Neal is
attempting to say that the services you provided were not medically
necessary. As an MD, hold her to that.

 

If Dr. O'Neal is present, that will be the longest part of the hearing.
Generally, you just state your case and the judge will allow Dr. O'Neal to
present her side. Sometimes the judge will ask you questions concerning the
specific device you provided, but some judges don't ask any questions.

 

Overall, stay calm, be respectful and be concise. It goes a long way.

 

Let me know if you have any other questions.

 

Best regards,

 

 

Sara Beck
Appeals Specialist
San Joaquin Orthotics & Prosthetics
2211 N. California Street
Stockton, CA 95204
209.932.0170
209.932.0172 Fax
RAC Support < <URL Redacted>>

Holy moly. I know what office one of our hearings has been assigned to and
I've left them a couple messages to follow up on the date, however, they
have not returned any of my messages.

 

Thank you

I have had 3 go this level. All 3 were ruled in my favor without all the
hoopla of going through the hearing process. I spend hours organizing my
data, preparing for all the anticipated questions, prepping my patient for
what could be asked and how he should respond, etc. I lost sleep worrying
about it all and ended up getting an office phone call (the day before the
hearing date) that the judge ruled in our favor and we didn't need a phone
hearing. I hope your results are the same!!! I did, by the way, have a
good case and did not understand why it had progressed to that level. But
perhaps that explains the 2 year processing delay. Perhaps many should not
have progressed to that level. Good luck.

 

Joan Cestaro, CP

 

 

Maybe you should invite the patient's MD to the hearing
if he has
the patients best interest. MD to MD review of the case.
 
Just a thought.


Lana, we had our first hearings in Feb. We did 3 at the same time. We got
the results about a month later--we won all 3! We got paid about a month
after that. They were our first ones so we were pleasantly surprised. The
judge was very nice and patient.The first thing he did was ask us to present
our case. That was the hardest part because we weren't sure what he was
looking for, but we just repeated all of the grounds for our dispute that we
had submitted previously. We were organized and had all of our information
in front of us, but he did not rush us as we looked for info in the records.
He asked a number of questions and we were able to answer all of them. The
Noridian MD mostly listened and did not dispute anything we said. She
actually complemented us on our presentation. Good Luck! Kathy Chavez,
Vogue Prosthetics

Unfortunately I had a hearing in November and still haven't got a response.
I'm in the process of taking it to the next level because the judge won't
finish the paperwork he's too far backed up he says.

 

Hi there. I had one with the MD present. At the end of my passionate plea
the MD had her turn and simply stated Medicare had made a mistake. I won!!

When I have the next one I will ask if the MD can go first.

Why the hell don't they just admit they were wrong first and avoid all the
hassle and stop wasting the courts time. This whole thing is messed up!

Linda

 

good luck,,its intimidating,,the md may be on video or phone,,,they shot me
down because there was no medical records but the judge had 2 feet in front
of them the Racs lie,,,,,her ruling took 8 months and there was still some
missing charts,,My attorney wanted ruling on all the patients,,wrong idea
that was to generate another 30,000. dollars for him,,,ask for a ruling on
all the charts that are present before the judge,,,don't take any appliances
in or devices,,this is paper chase,,if your paper work is adequate you may
get paid,,good luck your not the bad guy,,,Robert

 

I also received a phone call from Rae who was extremely knowledgeable and
helpful- 800-460-0288/ 720-344-1212 She had successful experiences.