Why you should use the new request for hearing form – racmonitor

The advent of revised regulations for administrative law judge (ALJ) hearings of Medicare appeals includes a new request for ALJ hearing or review of dismissal form.

Because the new form — governed by 42 C.F.R. Healthcare information systems § 405.1014 — provides a logical flow of information for you and the public servants handling your appeal, you should use the form for every new appeal you file. What is health informatics and information management The form, Office of Medicare Hearings and Appeals No. Health care information OMHA-100, is available online at https://www.hhs.gov/sites/default/files/OMHA-100-Request-for-Hearing-or-Review-of-Dismissal.pdf.

Section 1 identifies the part of Medicare under which you are appealing. Health information exchange vendors In Section 2, you are asked to tell OMHA who you are and outline your role in the case. Health information exchange Section 2 also helps OMHA expedite individual beneficiaries’ appeals, which OMHA still expects to decide within 90 days of filing.

Pursuant to 42 C.F.R. Health information systems § 405.1014(a)(1)(i) through –(iii), all appellants must provide a telephone number in Section 3 or 4 of the form. Veterans health information systems and technology architecture This includes individual beneficiaries.

Representatives must complete Section 4 and attach a CMS-1696 appointment of representative form or other appointment of representative documentation if they answered “no” to the last question in Section 4, asking whether they previously submitted and detailing the appointment of a representative. 3m health information systems Privacy rules require an appointment of representative if you want OMHA to talk with you about a case you file for someone else.

In Section 5, you must provide the Medicare appeal or qualified independent contractor (QIC) number assigned to the QIC reconsideration or notice you are appealing (see 42 C.F.R. Information of health § 405.1014(a)(1)(iv). Information about healthy living Why do you have to provide the QIC number? OMHA needs it to request the case file from the QIC.

42 C.F.R. Information about healthy diet § 405.1014(a)(1)(v) now requires appellants to specify the dates of service (DOS) of the claims they are appealing. Health information exchange challenges Because beneficiaries may have been hospitalized more than once, in home health, therapy, or hospice for multiple periods, or received more than one shipment of supplies or durable medical equipment (DME), providing dates of service and the QIC number ensures that the ALJ or attorney adjudicator will review and decide the correct claims.

Healthcare professionals asking for an expedited hearing arising out of a Part D drug denial must explain in Section 6 why waiting the standard 90 days for a decision may jeopardize the beneficiary’s health, life, or ability to regain maximum function.

In Section 7, explain why you disagree with the denial or dismissal. Free health information It’s acceptable to write: “the record supports payment for the services appellant provided the beneficiary on (DOS); please refer to attached letter (or proposed decision).”

If you are submitting new evidence and are a provider or supplier (or a provider or supplier representing a beneficiary), you must indicate that in Section 8 – and explain why you didn’t previously submit the evidence before the QIC’s reconsideration decision, per 42 C.F.R. Health information systems pdf § 405.1018(d) and 42 C.F.R. Latest health information § 405.1028(d). Medical health information You must submit that “good cause” statement with the request for a hearing, or if you submit the evidence later, with the evidence. Health information websites You cannot wait until the hearing to submit your good cause statement – the ALJ or attorney adjudicator cannot consider it if you wait.

In Section 9, you advise if you are aggregating claims to meet the amount in controversy requirement, waiving an oral hearing and requesting an “on-the-record” decision issued without a hearing, or filing a statistical sampling claim. What is health care information Waiving an oral hearing and requesting an on the record means your case may be assigned to an attorney adjudicator, who is a licensed attorney knowledgeable about Medicare coverage and payment policy, per 42 C.F.R. Health information systems management § 405.902, 42 C.F.R. Interoperability of health information systems § 405.1036(b)(2), and 42 C.F.R. What is health information exchange § 423.2036(b)(2).

42 C.F.R. What is a health information manager § 405.1014(d)(1) and –(2) – and the new request for hearing form – require you to recite to whom and when you mailed a copy of your request for hearing, including the recipient(s) name, mailing address, city, state, and ZIP code. Health information services Your mailing must also include a copy of your position paper, brief, or proposed decision. Health information exchange hie Providing information about who you served with copies, and when, allows your hearing request to be placed in line for processing.

Hearing requests that do not include service of copy information will be further delayed while OMHA asks for that information, typically with a notice to correct deficiency. Health management information system hmis Failure to correct the deficiency in the allowed time will result in dismissal of the request for hearing, per 42 C.F.R. Health and disease information § 405.1014(d)(3), 42 C.F.R. Information about health insurance § 405.1052(a)(7), and 42 C.F.R. Masshealth information § 405.1052(b)(4). What is health information Dismissal for failing to document providing a copy does not apply to individual beneficiaries.

Send your request for hearing to the entity specified in the reconsideration decision. Information about health and fitness If the reconsideration denial or other order directs you to send it to OMHA, Section 11 provides addresses and mail stops.

Using the new form ensures that you provide all the information you need to perfect your appeal. Types of health information systems Using the form helps the intake clerks in centralized docketing and eventual ALJ legal assistants quickly input your appeal information. Reliable health information Help yourself, and help OMHA help you. Patient health information Use the form.

Bob Soltis is a success coach and the author of How to Handle Your Medicare Hearing. What is health information systems A former U.S. Health information systems jobs Navy officer, he decided 4,500 cases during eight years as an ALJ at OMHA.

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