Getting Heard: Working with the Updated Medicare Administrative Review Process

Level: Advanced
Runtime: 93 minutes
Recorded Date: November 30, 2017
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12:00 pm - 1:30 pm
  • OMHA Jursdiction and Workload
  • Medicare Appeals Process History
  • Select Provisions of the Final Rule
    • Attorney Adjudicators
    • Request for Hearing and Review
    • CMS and CMS Contractor Roles
    • Streamlined Authorities

Runtime: 1 hour and 33 minutes
Recorded: November 30, 2017


In this webinar, our panel of experts will provide an overview of the regulatory changes in the January 17, 2017, final rule and share what you need to know to counsel your clients effectively.

Over the last several years, the Medicare benefit and claims appeal process has experienced a significant increase in the number of appeals being filed which, coupled with only modest increases in funding, has created a significant backlog of appeals at the third and fourth levels of appeal. The U.S. Department of Health and Human Services (HHS) has taken a number of actions to address the backlog, including the implementation of a final rule designed to streamline the administrative appeals process, increase consistency in decision-making across appeal levels, improve efficiency for both appellants and adjudicators, and expand the available pool of adjudicators at the third level of appeal.

Our discussion will include the Medicare Act's exhaustion requirement, which requires providers and enrollees to channel certain claims through the Medicare administrative review process. The exhaustion requirement can be a powerful shield for Medicare Advantage plans, as state and federal courts around the country continue the trend of dismissing lawsuits by enrollees and providers that failed to exhaust administrative remedies for claims that "rise under" the Medicare Act.

This program was recorded on November 30th, 2017.

Provided By

American Bar Association


Harsh P. Parikh

Nixon Peabody LLP

Harsh works with managed care organizations, hospital systems, and other providers on a wide range of regulatory, reimbursement, and transactional matters. His practice encompasses federal and California fraud and abuse compliance, licenses and permits, Medicare and Medicaid (Medi-Cal) participation and reimbursement, False Claims Act internal and government investigations, and enforcement actions. Harsh also advises clients on health information technology, bioethics, privacy, security compliance, digital health, and telemedicine matters.

Angela K. Roach

Special Assistant to Chair, Department Appeals Board
U.S. Department of Health & Human Services

Charels (Charley) Koch

Branch Chief, Program Operations
U.S. Department of Health and Human Services

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