Results 1 to 3 of 3


  1. Default ALJs
    New Call-to-action
    Have any of you gone in front of an ALJ for a third level Medicare appeal? If so, any direction or advice would be extremely helpful and appreciated.

  2. Default
    You can do them over the phone. I have requested one or two for my physician. In both cases, the judge only wanted to talk to the physician so I couldn't really do anything.

    To set it up, we sent in our request per the instructions on the reconsideration denial. The ALJ's office will call to set up a time when your physician can get on the phone to review the case and then the ALJ's office will call back at that date and time for the hearing.

    The physician usually needs to give his/her credentials before getting into the detail of the appeal. The whole thing usually takes about 10-15 minutes - at least in our case. The appeal I listened to was for a bundling denial. The surgeon explained why the procedure was necessary for the patient and he explained how the "bundled" procedure was not an integral part of the primary procedure & should be paid separately. The judge asked a few questions while reviewing the records & then agreed with our arguement. We subsequently received a separate payment.

    Hope this helps.

    Lisi, CPC

  3. Default
    thank you so much! very helpful, i appreciate it.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.