OMHA Implements Expanded Dispute Resolution Process for Medicare Providers

Healthcare providers and suppliers that bill Medicare may appeal a denial or a reduction of a claim for Medicare reimbursement through Medicare’s administrative appeals process.¹ Over the last 10 years, 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 at the third level of the appeals process, which involves a hearing before an Administrative Law Judge (ALJ), Medicare appeals are to be heard and decided within 90 days; however, recent statistics released by OMHA reveal that the average current processing time for appeals before ALJs is nearly 1,142 days.²