Hello list,
So far I had four responses to my query: How many of you are requesting a hearing with the ALJ versus asking them to make a decision based on what information has already been submitted? Is there a difference in the success of the appeal when a hearing is requested? What advantages or disadvantages are there in requesting a hearing?
By the way, I have always planned on taking the appeal as far as we can go, so it wasn’t a matter IF I should take it to the ALJ, but rather the difference between the ALJ reviewing and deciding the case on it’s merits or in fact do I need to have a hearing to explain everything that we have to support our case. The responses are below:
– We appeal all the way to the ALJ level in almost every case. We rarely have to attend a hearing and I have never lost one yet. Also, I have never attended an ALJ hearing that was also attended by a Medicare representative so it is always just me and the ALJ. My assumption is that they know they will lose.
– I’ve taken a handful of cases to the ALJ level of appeals over the years (not for recent RAC audit claims). I’ve always had good luck with the judge, as they are human and really listen to the facts. My only advise to you if you do take it to the ALJ level is to have an outline in date sequence, of all that has transpired from initial eval, to delivery. This makes the process concise and to the point.
– Rick, any time I get a chance to plead my case before a judge I take it! They can use reason, logic, and other factors other than a strict often misinterpretation of policy that the other government employees use to treat us like criminals. I have never lost when dealing with an ALJ! The problem with the alternative is that they have already made up their minds that you are wrong and that they are right.
– You crazy if you don’t take it to the ALJ. Almost always successful when speaking with the judges. Be prepared. I did lots! Happy to answer questions.
Thank you very much for everyone’s responses,
Rick Stapleton, CPO
NOTE: The information in this email and any attachments may be confidential and/or medical privileged. Access to this email by anyone other than the intended addressee is unauthorized. If you are not the intended recipient (or the employee or agent responsible for delivering this information to the intended recipient), please notify the sender by reply email and immediately delete this email and any copies from your computer and/or electronic storage system. The sender does not authorize the use, distribution, disclosure or reproduction of this email (or any part of its contents) by anyone other than the intended recipient(s). No representation is made that this email and any attachments are free of viruses. Virus scanning is recommended and is the responsibility of the recipient.
