Wednesday, January 22, 2014

Medicare's Office of Hearing & Appeals

The Office of Medicare Hearings & Appeals (OMHA) released a notice that they are receiving so many appeals, that there is a long wait for a decision.  The website gives the following timeframes:

Due to record receipt levels, we are currently projecting an 18 to 22 week delay in entering (“docketing”) new requests into our case processing system. If 22 weeks have not lapsed since you submitted your Request for Hearing, do not resubmit your request.

 Based on our current workload and volume of new requests, we anticipate that assignment of your request for hearing to an Administrative Law Judge may be delayed for up to 28 months.

The average processing time for appeals decided in fiscal year 2014 is 301.7 days.

They are also delaying assignment of those cases filed after April 1, 2013:

OMHA implemented a program that defers the assignment of most requests for hearing received after April 1, 2013. Under this new docketing process, new requests for hearing will be entered into our case processing system, then held until they can be accommodated on an Administrative Law Judge's docket for adjudication.

Due to the volume of requests that we are receiving, there are significant delays in assigning requests at this time.  When your request is assigned to an Administrative Law Judge, we will send you a Notice of Assignment. Based on our current workload and volume of new requests, we anticipate that assignment of your request for hearing to an Administrative Law Judge may be delayed for up to 28 months.

Not only that, but OMHA also has suspended for two years the filing of ALJ appeals by Medicare Recovery Audit Contractors (RAC) in order for the ALJs to catch up with the backlog of cases.

The Washington Post ran an article by Susan Jaffe of Kaiser Health News (KHN) that notes that Medicare will give beneficiary claims priority in processing, and HHS published a notice in the Federal Register explaining it.  The article quotes Judy Stein, Executive Director of the Center for Medicare Advocacy and prior NAELA President (full disclosure-I'm on the CMA board and a friend of Judy's).

Wow, Medicare OMHA sure is busy. 

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