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Medicare Appeals - New Developments, Old Delays

Office of Medicare Hearings and Appeals (OMHA) recently created a new website to facilitate monitoring of ALJ appeals. Physicians, DME suppliers & other providers can now check on the status of filed Medicare reimbursement appeals, find useful documentation as well as other information pertinent to the appeal.

OMHA also launched listserv website which gives access to pilot programs, special initiatives, updates regarding the Medicare appeals process and other useful information. The ALJ Appeals Information System (AAIS) website offers detailed official appeal status data which will ease the process of obtaining proof from OMHA that ALJ appeal is on file. The AAIS website will show 4 stages the appeal status: received, assigned, deliberation and decided.

However, providers shall be aware that the appeal process will not be expedited. It will take at least 4 months from the date of filing the appeal for OMHA to upload it into OMHA's tracking system and post the status on the website. Moreover, providers that have appealed through CMS will not have the opportunity to review their appeal status online.

On average, it takes 2 years to issue a decision by ALJ. As of December 2014, OMHA backlog was nearly 1 million appeals. Despite that, over 42% of appeals have received fully favorable rulings by ALJ last year. Even though, OMHA appeal process is long lasting and complex it may be well worth waiting for.

If you need help filling an appeal before ALJ or require additional information as to the OMHA appeal process do not hesitate to contact our knowledgeable and experienced healthcare attorneys at 212-668-0200 or by email info@mdrxlaw.com. If you would like to contact the publishing attorney Kristina Giyaur, Esq. directly please email kgiyaur@mdrxlaw.com

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Monday, November 30, 2020