I am a physician working on an appeal of an ALJ decision concerning Medicare Payment denial. I am appealing his decision to the Medicare Appeals Council.
1). Good news: there are a lot of cases concerning principles governing ALJ's when they determine Soc Sec Disability claims. These cases involve exactly the same chart notes, medical principles, types of cases as the Medicare Payment denial cases. There are a great many of these available to review.
2). Bad news: there are relatively very few cases concerning principles governing ALJ's determinations in Medicare Payment denial appeals, because payment denial has only recently become popular and "vogue" under the present administration........
I need to be able to apply the same principles, decisions, rulings, etc used in the SSD cases, to Medicare payment denial cases. They both utilize ALJ's, both are part of the Social Security Administration, etc. Appeals from Medicare ALJ's go to the Medicare Appeals Council. Don't know where the others go. The dudes on Westlaw tried but really didn't help much. Can anyone here please point me in the right direction?

