ExpiredWriting Winning Appeals in the NEW ALJ Environment

  • November 1, 2018
    12:00 pm - 1:30 pm

Recent statistics show that something has changed at the Administrative Law Judge (ALJ) level. The overturn rate has drastically fallen over the past year. If you receive a denial of your claim, how do
you know what to do to meet the higher, more difficult standard that is being set now? Now, more than ever, dealing with the Medicare appeals process can be confusing and frustrating. Gleaned from
thousands of appeals and hundreds of hearings, we will address the appeal process, preparation, and presentation tips for ALJ hearings to push you towards success, including laying the groundwork
during the entire Medicare appeals process to build toward a winning presentation. This also includes guidance on writing lower level appeals that both support payment at earlier levels of appeal and build a strong foundation for the hearing. For the ALJ hearing, it introduces procedural documents,  administrative tasks prior to the hearing, how to prepare for the hearing, and presentation pointers to
maximize the chance for a successful outcome. The appeals process is not an experience we wish to have, but home health agencies can put a positive spin on it as a staff development and learning


Presented By Joseph Osentoski, BAS, RN-BC
Joseph Osentoski, BAS, RN-BC, is Reimbursement Recovery & Appeals Director at QIRT (Quality In Real Time). He has been a registered nurse for more than 25 years in home health and hospice.
Joe specializes in handling ADRs and appeals, completing over 5,000 since 1997. His specialty is clinical consulting, including quality assurance and regulatory compliance with a focus on Medicare audits (ZPIC, UPIC, RAC, OIG), probes (TPE), and all levels of appeals, including ALJ hearings with all OMHA offices.


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