The Office of Medicare Hearings and Appeals (OMHA), a division of HHS that administers the Administrative Law Judge (ALJ) hearing program for Medicare claims appeals, recently issued a Request for Information (RFI) seeking suggestions for addressing the growth of hearing requests and the current backlog of pending ALJ appeals. OMHA requests public suggestions for (i) improving any current initiatives for addressing the increased workload and backlog of ALJ appeals; (ii) establishing new initiatives; and (iii) revising any current regulations that apply to the ALJ level of the appeals process that could streamline the adjudication process, while ensuring that appellants are given opportunities to participate in the process and are kept apprised of their appeals. Comments on the RFI are due on December 5, 2014.
The RFI notes that OMHA has experienced a significant increafse in appeals workload, which is attributable to a variety of factors, including Medicaid State Agency appeals of Medicare coverage denials for dually enrolled beneficiaries, and implementation of the Recovery Audit Contractor program. The RFI notes that ALJs saw a 506 percent increase in the number of appealed RAC denials from 2012 to 2013. The RFI is available here.