Corporate Compliance

Medicare appeals process improving

Healthcare Auditing Weekly, February 3, 2009

The Office of Medicare Hearings and Appeals (OMHA) has improved its decision-making time and increased its caseload by 37% since its inception in 2005, according to an OIG report on the operation of the office.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 required the Department of Health and Human Services (HHS) to assume the responsibility of conducting Administrative Law Judge (ALJ) hearings. The HHS created the OMHA in 2005 to hear ALJ hearings, which is the third level in the Medicare appeals process.
The Senate Finance Committee requested the OIG conduct an assessment of the OMHA in September 2008. The OIG compared the operation statistics from the OMHA’s first year to its third year and published the findings
  • Increased its caseload by 37 percent
  • Improved the timeliness of its decision-making: For cases that had a 90-day decision requirement, the OMHA decided 94% of these cases on time, versus 85% in 2005. For cases without a 9-day decision requirement, the OMHA decided the majority of these cases within six months.
  • Improved the quality of the data in the appeals system from its first year of operation to its third.


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