September 01, 2017

Medicare Appellants Should Consider Participation in OMHA’s Statistical Sampling Initiative

Andrew B. Wachler and Erin Diesel Roumayah, Wachler & Associates, P.C., Royal Oak, Michigan

Over the last half-decade, healthcare providers have experienced increasingly excessive adjudication delays in the Medicare appeals process. The appeals process was designed to afford an efficient and prompt resolution to appeals. However, the Office of Medicare Hearings and Appeals (OMHA), the entity which processes such appeals, began receiving more appeals than it could process, causing a severe delay in appeals adjudication. Federal statute mandates that OMHA’s Administrative Law Judges (ALJs) hear and decide Medicare appeals within 90 days of receipt of a request for hearing.1 According to statistics released by the U.S. Department of Health and Human Services (HHS), OMHA’s average appeal processing time has steadily risen each year since fiscal year 2009.2 Most recent statistics indicate that in the second quarter of fiscal year 2017, OMHA’s average appeal processing time topped 1,057 days.3 In other words, although providers are statutorily entitled to a Medicare hearing and decision within 90 days, due to the overburdened appeals system they must wait nearly three years.

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