Tag: OMHA
OMHA reduces ALJ backlog
November 19, 2020HME News Staff
WASHINGTON - The Office of Medicare Hearings and Appeals is back to operating at full capacity and is making its way through a backlog of appeals at the Administrative Law Judge level, AAHomecare reports. As of Oct. 31, 2020, there are about 85,000 DMEPOS appeals pending at the ALJ, a decrease of 51% compared to nearly 173,000 in 2019. OMHA also reported that the average wait time for an ALJ hearing is still four years, but it believes that should decrease as judges work their way through the backlog....
HHS reports 25% reduction in appeals backlog
October 16, 2019HME News Staff
WASHINGTON - The Department of Health and Human Services has reduced the backlog of Medicare appeals at the administrative law judge level by 25% through June 30, according to a status report provided to a federal court and obtained by the American Hospital Association.
The status report is part of a federal court ruling last year that established annual deadline-based targets for reducing the backlog of Medicare appeals at the ALJ level.
From Nov. 1, 2018, through the end of the third quarter...
In brief: HHS details status of appeals backlog, supplier dropped from lawsuit
December 1, 2017HME News Staff
FALLS CHURCH, Va. - The Office of Medicare Hearings and Appeals receives more than a year's worth of appeals work every 24 weeks at the third level of appeals, according to a recent PDF posted to the agency's website.
As of the end of the fourth quarter of fiscal year 2016, the pending workload at the administrative law judge level exceeded 650,000 appeals, while annual adjudication capacity going forward was about 92,000 appeals, according to the “HHS Primer: The Medicare Appeals...
HHS details status of appeals backlog
November 29, 2017HME News Staff
FALLS CHURCH, Va. - The Office of Medicare Hearings and Appeals receives more than a year's worth of appeals work every 24 weeks at the third level of appeals, according to a recent PDF posted to the agency's website.
As of the end of the fourth quarter of fiscal year 2016, the pending workload at the administrative law judge level exceeded 650,000 appeals, while annual adjudication capacity going forward was about 92,000 appeals, according to the “HHS Primer: The Medicare Appeals...
CMS offers appeals settlement
November 9, 2017HME News Staff
WASHINGTON - CMS recently announced a low volume appeals settlement for Part A and Part B appeals at the Office of Medicare Hearings and Appeal and the Medical appeals Council. The option is limited to appellants with less than 500 appeals and each individual appeal must total $9,000 or less. The settlement is for 62% of the allowed amount minus the copay, according to a bulletin from AAHomecare. As of August 2017, OMHA had 591,962 total appeals pending—an increase of 300% since 2016. The number...
ALJ wait time increases
May 27, 2016Theresa Flaherty, Managing Editor
WASHINGTON - The wait time for an Administrative Law Judge hearing keeps growing—a symptom of ongoing problems with the audit process, say industry attorneys.“I don't think the problem lies in appeals,” said Ross Burris, an attorney in the Atlanta office of Polsinelli. “The problem lies lower down, either with audits that are too broad, or MACs that are just rubberstamping what the audit contractors are doing.”In the first quarter of 2016, the wait was 796 days. By the...
Short takes: OMHA, NCART, Great Lakes
February 3, 2016HME News Staff
The Office of Medicare Hearings and Appeals will host the fourth Medicare Appellant Forum via webinar/teleconference on Feb. 25 from 1 p.m. to 4 p.m. It plans to discuss updates on steps that it and the Department of Health and Human Services are taking to address a huge backlog at the administrative law judge level of the appeals process. OMHA last held a forum in June 2015…Long-time complex rehab advocate Finn Bullers passed away on Jan. 30 from complications of an illness, according to NCART....
Hopes are high for tweaks to settlement process
September 25, 2015Tracy Orzel
WASHINGTON - The Office of Medicare Hearings and Appeals plans to expand its Settlement Conference Facilitation pilot project and stakeholders hope the agency will make it more widely accessible.
Right now, to participate in the pilot project, providers must have a minimum of 20 claims or $10,000 in controversy; must appeal all claims for the same service; and must have filed the claims in 2013—none of which can be currently assigned to a judge.
Due to these strict criteria, very few...
OMHA to expand settlement process for appeals
September 22, 2015HME News Staff
WASHINGTON - The Office of Medicare Hearings and Appeals will expand a pilot project that it launched last year that seeks to settle appeals that are stuck at the administrative law judge level.OMHA has announced that it will hold a conference call on Oct. 15 to discuss its plans to expand its Settlement Conference Facilitation pilot project.The office did not provide details on how it plans to expand the pilot project, but it stated: “The teleconference will brief appellants on how they can...
Hospitals take up CMS on offer
June 18, 2015HME News Staff
WASHINGTON - Recent settlements of pending appealed claims between CMS and hospitals have given stakeholders hope that a settlement with HME providers is also possible.As of June 1, CMS has paid $1.3 billion from the Medicare Trust Fund to settle 300,000 pending appealed claims from more than 1,900 hospitals, according to an update.Back in August, CMS offered “an administrative agreement to any acute-care hospital or critical access hospital willing to resolve their pending appeals (or...