Part B Insider (Multispecialty) Coding Alert
ALJs Move Out of Social Security Administration
Not all of the items passed in the "Regulatory Reform" section of the newly enacted Medicare law are good for home care providers.
For example, Section 931 of the law requires administrative law judges to move from the Social Security Administration to the Department of Health and Human Services by October 2005. ALJs hear appeals regarding Medicare claims and often reverse contractor determinations.
"Although the law requires steps to be taken to ensure the independence of ALJs after the transition, it is difficult to conclude that the number of positive outcomes for providers will remain the same," says Burtonsville, Md.-based attorney Elizabeth Hogue.
The ALJs have been a "reality check" for Medicare contractors making claims determinations, Sarraille says. Moving them to HHS will undermine the independence that made them a fair avenue for Medicare appeals.
Part B Insider (Multispecialty) Coding Alert
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