Re: Administrative law judge hearing

[Guest guest]

Good evening!

I was involved in one Administrative Law Judge hearing in a SNF.

We did all the correspondance in writing and won the appeal! We had the

option of a phone conference but chose not to go that route. Good luck!

Rich PT

Honey Hill Rehabilitation and Nursing Center

Norwalk, CT 06851

On Thu, 11 Aug 2011 23:54:26 -0000 " goodrehabla "

writes:

Dear group,

For those of you who have gone through the Medicare denied claims appeal

process, has anyone gone to the 3rd level which is the Administrative Law

Judge hearing? I understand it is done by video teleconference.

Does the judge and the provider sit infront of a web cam and discuss the

case? The information sheet I have does not go into much details about

the process.

Thank you in advance for any kind of input!

Hailey J.

Good Rehab Physical Therapy

Goodrehab@...

____________________________________________________________

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[Guest guest]

I have gone to the ALJ level about a dozen times; however, it has been

several years ago in my past life. When I went it was in an federal

office-judicial complex. The Judge would enter and sit on raised platform.

It's all very formal with court reporter and records being present. You may

have option to supply additional documentation on the day of the appeal .

they would have a person come out a little while before trial to ask if we

had those for submission.

I was quiet amazed at the knowledge level of the judge in the cases and his

questions as to detail. They knew the case before we started talking. It

is certainly NOT a " push over " and expect some detailed questions. We were

lucky to be many hours from the intermediary office and they never sent

anyone to argue their side. I typically left unsure of results and you have

to wait weeks for those to arrive. They may have switched to video in some

areas but I would expect it's the same intensity level.

My advice is to prepare with someone who has been thru the process if

possible, have your notes with you and highlighted, understand the case, and

be concise and professional. It's not pleasant, its closer to a trial

atmosphere. Stand on the merits of your case and be ready for the judge

(or insurance company) to point out the weakness of your case.

Steve Passmore PT, MS

Healthy Recruiting Tools

spass@...

Phone:

Fax:

" What We Did For You Yesterday Is History. What Can We Do For You Today "

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Design ~ Recruiting Software

From: PTManager [mailto:PTManager ] On Behalf

Of goodrehabla

Sent: Thursday, August 11, 2011 6:54 PM

To: PTManager

Subject: Administrative law judge hearing

Dear group,

For those of you who have gone through the Medicare denied claims appeal

process, has anyone gone to the 3rd level which is the Administrative Law

Judge hearing? I understand it is done by video teleconference.

Does the judge and the provider sit infront of a web cam and discuss the

case? The information sheet I have does not go into much details about the

process.

Thank you in advance for any kind of input!

Hailey J.

Good Rehab Physical Therapy

Goodrehab@... <mailto:Goodrehab%40gmail.com>

_____

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[Guest guest]

I have gone through two different times regarding the medicare appeals process;

however, I never had to go before a judge.  I went through for approval of a

new wheelchair and medical necessity of wound vac system.  The interview

consisted of a telephoned interview with the appropriate DME, PT and progress

notes and any other information I had.  The first one got the wheelchair as it

was welded several times on the frame; the second one didn't quality due to

Medicare indicating in its paperwork that it didn't cover Vac traetment for the

lady's particular prolbem.  If you have a justifiaboe case with correct

documentation, you sgo fairly welll  good luckk s whitney

________________________________

To: PTManager

Sent: Thursday, August 11, 2011 6:54 PM

Subject: Administrative law judge hearing

 

Dear group,

For those of you who have gone through the Medicare denied claims appeal

process, has anyone gone to the 3rd level which is the Administrative Law Judge

hearing? I understand it is done by video teleconference.

Does the judge and the provider sit infront of a web cam and discuss the case?

The information sheet I have does not go into much details about the process.

Thank you in advance for any kind of input!

Hailey J.

Good Rehab Physical Therapy

Goodrehab@...

[Guest guest]

Hailey,

 

You may find the following reference beneficial:

 Medicare Claims Appeals Process

Handbook

by Lester J. Perling

 

Published by Aspen Publishers

 

 

 

Sumesh , PT

To: PTManager

Sent: Thursday, August 11, 2011 7:54 PM

Subject: Administrative law judge hearing

 

Dear group,

For those of you who have gone through the Medicare denied claims appeal

process, has anyone gone to the 3rd level which is the Administrative Law Judge

hearing? I understand it is done by video teleconference.

Does the judge and the provider sit infront of a web cam and discuss the case?

The information sheet I have does not go into much details about the process.

Thank you in advance for any kind of input!

Hailey J.

Good Rehab Physical Therapy

Goodrehab@...

[Guest guest]

A standard teleconference using phone only was used. Judge asked everyone to

identify themselves and their credentials.

Carol Rehder, PT

Manager, Physical Therapy

Genesis Medical Center

rehder@...

A J.D. Power and Associates

Distinguished Hospital for providing

" An Outstanding Patient Experience "

>>> " goodrehabla " 8/11/2011 6:54 PM >>>

Dear group,

For those of you who have gone through the Medicare denied claims appeal

process, has anyone gone to the 3rd level which is the Administrative Law Judge

hearing? I understand it is done by video teleconference.

Does the judge and the provider sit infront of a web cam and discuss the case?

The information sheet I have does not go into much details about the process.

Thank you in advance for any kind of input!

Hailey J.

Good Rehab Physical Therapy

Goodrehab@...

------------------------------------

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[Guest guest]

We completed one recently by teleconference. The Judge should have the

information you previously sent. Make sure you have your chart with you so you

can reference any needed information. In our conference, they asked who was in

the room, and then asked that one of us speak for the group. We were then sworn

in like a regular court of law. Discussed the case, and at the end, the judge

indicated he could not render his decision on the phone but would send a written

response with 30 days.

Diane , PT, DPT, MHA

Manager of Rehabilitation Services

Langlade Health And Rehabilitation

112 E. 5th Ave.

Antigo, WI 54409

PH:

FAX:

Nationally Ranked - Modern Healthcare's Top 100 " Best Places to Work in

Healthcare " (2009 & 2010)

From: PTManager [mailto:PTManager ] On Behalf Of

Carol Rehder

Sent: Friday, August 12, 2011 9:12 AM

To: PTManager

Subject: Re: Administrative law judge hearing

A standard teleconference using phone only was used. Judge asked everyone to

identify themselves and their credentials.

Carol Rehder, PT

Manager, Physical Therapy

Genesis Medical Center

rehder@...<mailto:rehder%40genesishealth.com>

A J.D. Power and Associates

Distinguished Hospital for providing

" An Outstanding Patient Experience "

>>> " goodrehabla " <goodrehabla@...<mailto:goodrehabla%40yahoo.com>>

8/11/2011 6:54 PM >>>

Dear group,

For those of you who have gone through the Medicare denied claims appeal

process, has anyone gone to the 3rd level which is the Administrative Law Judge

hearing? I understand it is done by video teleconference.

Does the judge and the provider sit infront of a web cam and discuss the case?

The information sheet I have does not go into much details about the process.

Thank you in advance for any kind of input!

Hailey J.

Good Rehab Physical Therapy

Goodrehab@...<mailto:Goodrehab%40gmail.com>

------------------------------------

In ALL messages to PTManager you must identify yourself, your discipline and

your location or else your message will not be approved to send to the full

group.

Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our

professions. PTManager is not available to support POPTS-model practices. The

description of PTManager group includes the following:

" PTManager believes in and supports Therapist-owned Therapy Practices ONLY "

Messages relating to " how to set up a POPTS " will not be approved

PTManager encourages participation in your professional association. Join APTA,

AOTA or ASHA and participate now!

Follow Kovacek, PT on Facebook or Twitter.

PTManager blog: http://ptmanager.posterous.com/

[Guest guest]

I as well had one that we won by phone hearing. Just have all your ducks in

a row.

Mark Niles PT, MS, CSCS

Orthopedic Specialists PA

mniles@...

x3

fax

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From: PTManager [mailto:PTManager ] On Behalf

Of Steve Passmore

Sent: Thursday, August 11, 2011 10:49 PM

To: PTManager

Subject: RE: Administrative law judge hearing

I have gone to the ALJ level about a dozen times; however, it has been

several years ago in my past life. When I went it was in an federal

office-judicial complex. The Judge would enter and sit on raised platform.

It's all very formal with court reporter and records being present. You may

have option to supply additional documentation on the day of the appeal .

they would have a person come out a little while before trial to ask if we

had those for submission.

I was quiet amazed at the knowledge level of the judge in the cases and his

questions as to detail. They knew the case before we started talking. It

is certainly NOT a " push over " and expect some detailed questions. We were

lucky to be many hours from the intermediary office and they never sent

anyone to argue their side. I typically left unsure of results and you have

to wait weeks for those to arrive. They may have switched to video in some

areas but I would expect it's the same intensity level.

My advice is to prepare with someone who has been thru the process if

possible, have your notes with you and highlighted, understand the case, and

be concise and professional. It's not pleasant, its closer to a trial

atmosphere. Stand on the merits of your case and be ready for the judge

(or insurance company) to point out the weakness of your case.

Steve Passmore PT, MS

Healthy Recruiting Tools

<mailto:spass@... <mailto:spass%40healthyrecruiting.com> >

spass@... <mailto:spass%40healthyrecruiting.com>

Phone:

Fax:

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From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf

Of goodrehabla

Sent: Thursday, August 11, 2011 6:54 PM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: Administrative law judge hearing

Dear group,

For those of you who have gone through the Medicare denied claims appeal

process, has anyone gone to the 3rd level which is the Administrative Law

Judge hearing? I understand it is done by video teleconference.

Does the judge and the provider sit infront of a web cam and discuss the

case? The information sheet I have does not go into much details about the

process.

Thank you in advance for any kind of input!

Hailey J.

Good Rehab Physical Therapy

Goodrehab@... <mailto:Goodrehab%40gmail.com>

<mailto:Goodrehab%40gmail.com>

_____

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Checked by AVG - www.avg.com

Version: 10.0.1392 / Virus Database: 1520/3828 - Release Date: 08/11/11