Medicare providers seeking administrative law judge reviews of claim denials had to have filed their requests prior to April 1, 2013 if they want avoid the current appeals delay of 30 months or more. That’s three months earlier than the HHS appeals office previously indicated.
 
In a recent memorandum to appeals applicants, the Medicare Office of Hearings and Appeals (MOHA) said the 30-month moratorium was “effective” for appeals filed after July 1, 2013. But in response to Home Health Line questions about the long delay, Nancy Griswold, MOHA’s chief ALJ, explained that  while July 1 was when the appeals office began applying “the deferral process,” it affected many cases filed prior to July 15, 2013 due to an already existing backlog. Appeals that already were assigned to an ALJ as of April 1, 2013 “are being adjudicated on a first-in, first-out basis,” Griswold’s response adds. The impact of the delay in ALJ reviews of claims denials is covered in more detail in the Jan. 20 issue of Home Health Line.