OMHA in Numbers: With More ALJs, There’s Progress With Appeals Backlog

The Office of Medicare Hearings and Appeals has made headway in reducing the Medicare appeals backlog, which means hospitals and other providers won’t have to wait as long to get a hearing on their appeals of claim denials, said McArthur Allen, the chief administrative law judge (ALJ), March 24 at the Institute on Medicare and Medicaid Payment Issues sponsored by the American Health Law Association.[1] As of Sept. 30, 2020, OMHA had 165,000 appeals pending, “a significant decrease from the fiscal year 2015 peak of 800,000 pending appeals,” he said. As a result, the appeals processing time is starting to drop. Allen attributes this to a number of factors. OMHA has added four appeal offices and a satellite office and hired 80 more ALJs (for a total of 160) and 29 attorney adjudicators as of Dec. 31, 2020. Visit OMHA at www.hhs.gov/omha.

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