CMS has announced the annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process, effective for requests filed on or after January 1, 2012. The calendar year 2012 AIC threshold amounts are $130 for ALJ hearings (unchanged from 2011) and $1,350 for judicial review (up from $1,300 in 2011).
On May 26, 2011, the White House posted the preliminary regulatory reform plans submitted by individual federal departments and agencies under President Obama's Executive Order 13563. The agency plans include both discussions of general approaches to regulatory review and listings of specific regulations that may be revised. HHS lists numerous current regulations it identifies as candidates for regulatory review over the next two years in order to increase flexibility and reduce regulatory burdens. Such rules include, among many others, Centers for Medicare & Medicaid Services (CMS) rules on: quality reporting, Medicare appeals, hospital conditions of participation, and revisions to reduce documentation burdens and clarify requirements under a variety of payment rules (impacting inpatient rehabilitation facilities, ambulatory surgical centers, hospices, outpatient hospital departments, and physicians). The Food and Drug Administration (FDA) listing includes such items as revisions to the FDA's bar code rule, good manufacturing practice (GMP) regulations for both food and drugs, and medical device adverse event report requirements.
CMS has announced its annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The 2011 AIC threshold amounts are $130 for ALJ hearings and $1,300 for judicial review. The new threshold amounts are effective for requests for ALJ hearings and judicial review filed on or after January 1, 2011.
On May 26, 2010, CMS is hosting a “Nationwide Section 935 Limitation on Recoupment Call for all Providers.” The call will to address a provision of the Medicare Modernization Act (MMA) of 2003 that prohibits the government from recouping Medicare overpayments when an appeal is received from a provider until a final decision is made.
On December 9, HHS published a final rule that will implement the procedures that HHS will follow at the Administrative Law Judge and Medicare Appeals Council levels in deciding appeals brought by individuals who have enrolled in the Medicare prescription drug benefit program. In addition, the regulation will implement the reopening procedures that will be followed at all levels of appeal. HHS also published a separate final rule regarding changes to the Medicare claims appeal procedures. The rule allows Medicare beneficiaries and, under certain circumstances, providers and suppliers of health care services, to appeal certain adverse determinations regarding Medicare Part A and Part B claims. Both rules are effective January 8, 2010.
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