December 01, 2018

OMHA Implements Expanded Dispute Resolution Process for Medicare Providers

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

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

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