CMS Updates “Amount in Controversy” Threshold Amount for Administrative Law Judge and Judicial Review for CY 2018

On September 29, 2017, CMS updated the Calendar Year 2018 “Amount in Controversy” thresholds for both Administrative Law Judge (ALJ) and judicial review.  When you appeal an adverse finding to Medicare, your first level appeal is known as Redetermination.  A second level appeal is known as Reconsideration.  The next higher level appeal is at the Administrative Law Judge (ALJ) and above that, if necessary, is judicial review.

CMS noted that for claims filed on or after January 1, 2018, the amount in controversy being disputed must reach $160 for ALJ, and for judicial review it must reach $1,600.  Link here to the CMS announcement.

As a point of reference, the CY 2017 “amount in controversy” amount for ALJ hearings was the same as the CY 2018 proposal ($160), but the 2017 judicial review threshold was slightly lower at $1,560.

We are happy to help with appeals, chart reviews, compliance, or other documentation and coding concerns.  Please contact us by phone or email, or on our “App”, Corcoran 24/7, which can be accessed via one of the below links.

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