A surge in Medicare claim appeals means agencies filing requests for hearings on Medicare contractor denials will have to wait almost two-and-a-half years (28 months) for these requests to be assigned to an administrative law judge (ALJ), the Office of Medicare Hearings and Appeals (OMHA) is warning providers. OMHA also announced that it expects an 18- to 22-week delay in entering hearing requests into its case processing system.
 
Although OMHA says the long wait has been in effect since July 2013, it only recently began sending out a “memorandum” describing the problem to providers that are seeking ALJ denials review. The memorandum explains that “exponential growth in requests for hearing” has created a current backlog of nearly 357,000 claims that already have been assigned to the 65 ALJs that hear Medicare appeal.  And hearing requests continue to pour in at the rate of 15,000 a week.
 
So far, OMHA hasn’t said what portion of the hearing backlog is due to requests from home health agencies and hospices. But the National Association for Home Care & Hospice notes that the massive upsurge coincides with the expanded number of Medicare contractors — MACs, ZPICs and RACs — reviewing claims and with a surge in retroactive claim denials related to the physician face-to-face encounter requirements. OMHA’s announcement appears on the U.S. Health and Human Services’ OMHA website at http://www.hhs.gov/omha/important_notice_regarding_adjudication_timeframes.html.