ALJ Hearings Remain a Good Appeals Option, OIG Report Notwithstanding

December 10, 2012 – In The News
Part B News

William H. Maruca discussed the OIG's recent report that may mean CMS and its contractors are likely to participate more actively in administrative law judge (ALJ) hearings in an attempt to uphold denials.

Maruca said he doesn't believe OIG is seeking to reduce the ALJ's power, but instead is seeking to limit their discretion by standardizing a system that they believe has become too subjective and variable.

He added if clear policies are developed as a result of the report, fewer claims will be appealed, and overturned, beyond the ALJ level.