ALJ decisions verses payment
Carey
Description
Collection
Title:
ALJ decisions verses payment
Creator:
Carey
Date:
9/28/2015
Text:
Guys, (only serious responses please)
I am interested in the connection between your ALJ decisions and your overall post decision payments. Here is the scenario in question. When you have appealed to the ALJ level and waited your two years. After you win your judgement, has CMS:
1) Reimbursed you what they recouped, plus interest, or have you had issues of CMS then refuting what they owe in spite of the judgement?
2) Have they claimed that some codes in the original claim set were non-medically necessary?
3) Has CMS stated that you did not include all of the codes in the original claim set with your ALJ level of appeal?
4) In other words, has CMS recouped money, and then when it was time to pay the money back, have they found some reason to keep some, or all, of your money?
PLEASE ONLY RESPOND WITH REAL SCENARIOS THAT YOU CAN PERSONALLY REPRODUCE.
Carey Jinright, LO, MSM
WDJD
Be an example, not an excuse!
Confidentiality Notice - The information contained in this e-mail and any attachments to it may be legally privileged and include confidential information. If you are not the intended recipient, be aware that any disclosure, distribution or copying of this e-mail or its attachments is prohibited. If you have received this e-mail in error, please notify the sender immediately of that fact by return e-mail and permanently delete the e-mail and any attachments to it. Thank you.
I am interested in the connection between your ALJ decisions and your overall post decision payments. Here is the scenario in question. When you have appealed to the ALJ level and waited your two years. After you win your judgement, has CMS:
1) Reimbursed you what they recouped, plus interest, or have you had issues of CMS then refuting what they owe in spite of the judgement?
2) Have they claimed that some codes in the original claim set were non-medically necessary?
3) Has CMS stated that you did not include all of the codes in the original claim set with your ALJ level of appeal?
4) In other words, has CMS recouped money, and then when it was time to pay the money back, have they found some reason to keep some, or all, of your money?
PLEASE ONLY RESPOND WITH REAL SCENARIOS THAT YOU CAN PERSONALLY REPRODUCE.
Carey Jinright, LO, MSM
WDJD
Be an example, not an excuse!
Confidentiality Notice - The information contained in this e-mail and any attachments to it may be legally privileged and include confidential information. If you are not the intended recipient, be aware that any disclosure, distribution or copying of this e-mail or its attachments is prohibited. If you have received this e-mail in error, please notify the sender immediately of that fact by return e-mail and permanently delete the e-mail and any attachments to it. Thank you.
Citation
Carey, “ALJ decisions verses payment,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237652.
