Administrative Law Judge Trial -- Simulation Proceedings

INTRODUCTION The denial of a prior authorization directly delays the ability to provide medically necessary care to a patient. The ability to navigate the appeal process in an effective, efficient and timely manner not only benefits the ability to provide clinical care but also has an immediate and direct impact on productivity and profitability to the facility. 

Learning Objective:

  • This presentation will provide a simulation of an ALJ trial, the 3rd and for all intents and purposes, the last effective stage within the Medicare System of appeals. 
  • The trial simulation will identify key elements of the process and procedure of an ALJ setting, from the viewpoints of the plaintiff (prosthetic provider), defendant (Medicare) and the Adjudication Law Judge.
  •  Focus will be on identifying the most common prior errors, omissions, and misconceptions of the ALJ to provide real life examples of effective trial procedures to implement and which ones to avoid.


Dale Berry, CP, FAAOP, LP

Owner

Prosthetic Xpert Consultation

Dale Berry, CP, FAAOP, LP is the owner of Prosthetic Xpert Consultation, LLC, and is licensed in Texas, Minnesota and Illinois and a Fellow of the American Association of Orthotists and Prosthetists. With over 40-years of clinical care experience Dale consults with national organizations with a focus on Clinical Operations, Regulatory Standards and Compliance.

Mitchell Dobson, CPO, FAAOP

SVP, Chief Compliance Officer

Hanger, Inc.

Mitchell Dobson, CPO graduated in 1994 from the University of Texas, Southwestern Medical Center in Dallas, Texas with a Bachelor’s Degree in Prosthetics and Orthotics. He completed his residencies in the Kansas City area and was certified in the 1990’s. Mitchell practiced in several states and was named a fellow of the American Academy of Orthotists and Prosthetists in 2005. He has also received a post-graduate certificate in Health Care Compliance from The George Washington University in Washington, D.C. Mitchell has been involved in O&P compliance for over two decades, currently employed by Hanger, Inc. as a Senior Vice President and Chief Compliance Officer. He was instrumental in developing Hanger’s compliance program and oversees all aspects of enterprise compliance. Mitchell is considered an industry leader in compliance, regulatory, and reimbursement matters. He is the current President of the American Orthotic and Prosthetic Association (AOPA), was a long-time member of AOPA’s Coding and Reimbursement Committee.

Lesleigh Sisson, CFo, CFm

Founder

O&P Insight

Lesleigh Sisson, the founder of O&P Insight, has been part of the orthotics and prosthetics profession since 1992. She started O&P Insight because she cares deeply about three things: helping people thrive in their professional lives, advancing the profession for patients & practitioners and leaving a legacy of lives impacted for the better. While she has always had a love of teaching and helping others, it was working in administrative and clinical support roles when Lesleigh recognized the desire to assist dedicated professionals working toward this common goal: providing excellent patient care while achieving the best possible health for the business. Lesleigh helps independent O&P practices to not only survive but also to thrive in today’s challenging and ever-changing healthcare environment with its demands for efficient work flow, revenue cycle solutions and successful compliance.

Kimberly Hanson

Kimberly Hanson is the Director of Reimbursement at Ottobock. Kimberly has been at Ottobock for over 12 years. Kimberly and her team manage all coding, coverage, and reimbursement strategies for new and existing products at Ottobock which include Orthotics and Prosthetics. Prior to joining Ottobock, Kimberly was the Director of Operations for a Hospital system and 6 patient care clinics. She managed all scheduling, billing, collections, and business development for the clinic system. Kimberly is a member of the DME MAC Advisory Councils for all 4 regions and recently became certified as a Consultant for Policy and Reimbursement for Healthcare (CPRH).

Key:

Complete
Failed
Available
Locked
Video
Open to view video.
Open to view video.
Quiz- Admin. Law Judge Trial
10 Questions  |  3 attempts  |  80/100 points to pass
10 Questions  |  3 attempts  |  80/100 points to pass
CE Credits
1.75 B credits  |  Certificate available
1.75 B credits  |  Certificate available