News & Analysis as of

OMHA

HHS Announces New Appeals Settlement Initiatives

by Reed Smith on

The HHS Departmental Appeals Board (DAB) is inviting the public to submit recommendations for precedential Medicare Appeals Council (Council) decisions that will be binding on all CMS, HHS, and Social Security Administration...more

CMS Announces Plans to Expand Settlement Options to Decrease Medicare Appeals Backlog

by King & Spalding on

On November 3, 2017, CMS announced that it plans to implement two appeals settlement initiatives designed to decrease the backlog of Medicare appeals pending at the Medicare Appeals Council (MAC) of the Department Appeals...more

Update: HHS Announces Two Additional Medicare Appeals Settlement Initiatives

by Polsinelli on

On Nov. 3, Health & Human Services (HHS) announced two additional initiatives to address the mounting Medicare appeals backlog at the Administrative Law Judge (ALJ) level: (i) expand the Settlement Conference Facilitation...more

Medicare Appeals Backlog: A Setback and New Opportunities for Providers

by McDermott Will & Emery on

As of June 2017, the Office of Medicare, Hearing and Appeals (OMHA) had 607,402 appeals pending with a current estimated wait time of three years for an Administrative Law Judge to process a provider’s appeal. At this rate,...more

DC Circuit Court Remands Medicare Appeals Backlog Case

by King & Spalding on

Last week, the United States Court of Appeals for the District of Columbia Circuit reversed and remanded the Medicare appeals backlog case American Hospital Association v. Price to the district court. As previously reported,...more

HHS Claims Budget Increases May Mean Reductions to Medicare Appeals Backlog

by King & Spalding on

In a status report filed in connection with the American Hospital Association v. Price case, HHS projects significant reductions to the Medicare appeals backlog if the “legislative and budgetary measures proposed” in the...more

Senate Finance Committee May Tackle Medicare Appeals Backlog

by King & Spalding on

According to Kimberly Brandt, Chief Oversight Counsel for the Senate Finance Committee’s majority staff, the Senate Finance Committee could reintroduce the Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of...more

HHS Finalizes Appeals Backlog Rule in Wake of Judicial Order

by Polsinelli on

The U.S. Department of Health and Human Services (HHS) released a Final Rule aimed at reducing and eventually eliminating the backlog of more than 650,000 claims currently awaiting adjudication by an administrative law judge...more

HHS Announces Final Rule on Medicare Benefit Claim Appeals Process

by King & Spalding on

On January 17, 2017, HHS published its final rule addressing modifications to the Medicare benefit claim appeals process. The final rule seeks to reduce the significant backlog of pending Medicare appeals and streamline the...more

HHS Publishes Final Rule Overhauling the Medicare Appeals Process

by Baker Ober Health Law on

The Department of Health and Human Services (HHS) published its final rule revamping the Medicare appeals process at the Administrative Law Judge (ALJ) level on January 17, 2017. The final rule extensively revises federal...more

CMS Finalizes Regulations with Hope of Reducing Medicare Appeals Backlog

by Reed Smith on

On January 17, 2017, CMS published the final rule titled “Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination...more

CMS Finalizes Rule to Reduce Medicare Appeals Backlog

by Reed Smith on

In the face of growing scrutiny and now judicial pressure, the Centers for Medicare & Medicaid Services (CMS) published a final rule on January 17, 2017 implementing certain administrative and procedural actions in an effort...more

HHS Announces Final Rule to Remedy Medicare Appeals Backlog

by Arnall Golden Gregory LLP on

On January 17, 2017, the Department of Health and Human Services (HHS) released a Final Rule announcing a three-prong appellate process change in an effort to decrease the growing Medicare appeals backlog at the...more

Birmingham Medical News: End in Sight for Medicare ALJ Backlog?

by Burr & Forman on

As providers who are currently undergoing a Medicare claims appeal know, there is a lengthy delay to having an appeal actually heard by an Administrative Law Judge (“ALJ”). Some estimates indicate that it will currently take...more

HHS Ordered To Eliminate Medicare Appeals Backlog By 2021

by BakerHostetler on

On January 4, 2017, the U.S. District Court for the District of Columbia rejected a request by the Secretary of HHS asking the court to reconsider its decision that requires HHS to eliminate the backlog of Medicare claims...more

Court Orders HHS to Fix the Medicare Appeals Backlog by the End of 2020

by Reed Smith on

Medicare providers with pending cases at the administrative law judge (“ALJ”) level received positive news last week as a federal judge for the United States District Court for the District of Columbia (the “Court”) granted...more

HHS Says Claims Appeals Backlog Is Decreasing and May Be Eliminated by the End of FY 2019

by King & Spalding on

On November 7, 2016, in the pending American Hospital Association (AHA) v. Burwell litigation, HHS filed a motion for summary judgment. A central focus of HHS’s motion for summary judgment is assertions that “the backlog is...more

CMS Still Finding Its Way Through Significant Medicare Appeals Backlog – Proposes New Rule in an Effort to Catch Up

by Reed Smith on

In the proposed rule, CMS focuses on taking administrative actions to alleviate the backlog, including introducing the concept of precedential decisions, delegating certain administrative law judge tasks to “attorney...more

HHS Proposes Rules to Streamline the Medicare Appeals Process to Address Backlog

by Reed Smith on

The Department of Health and Human Services (HHS) has issued a proposed rule intended to address the significant backlog resulting from “an unprecedented and sustained increase” in Medicare appeals. According to HHS, its...more

Medicare Appeals Backlog: HHS' Response to the Decade-Long Delay in Reviewing Appeals

by Baker Ober Health Law on

The Department of Health and Human Services (HHS) published its proposed rule [PDF] revamping the Medicare appeals process at the Administrative Law Judge (ALJ) level on July 5, 2016. The proposed rule extensively revises...more

HHS Proposes Significant Changes to ALJ Hearing Procedures

by King & Spalding on

HHS announced a Proposed Rule on July 5, 2016 aimed at reducing the backlog of appeals at the Office of Medicare Hearings and Appeals (OMHA) and Departmental Appeals Board (DAB) for Medicare payment and coverage...more

Office of Medicare Hearings and Appeals Launches Settlement Conference Facilitation Pilot for Medicare Part A Claims

by King & Spalding on

The HHS Office of Medicare Hearings and Appeals (“OMHA”) recently launched Phase III of the Settlement Conference Facilitation (“SCF”) Pilot to help resolve outstanding Medicare Part A appeals. The SCF program is one of...more

OMHA Expands Settlement Conference Facilitation Program to Part A Appeals: 10 Things to Know

by Polsinelli on

On Feb. 25, 2016, the Office of Medicare Hearings and Appeals (OMHA) conducted a teleconference to address Phase III of the Settlement Conference Facilitation (SCF) project, which also became effective on Feb. 25, 2016. SCF,...more

Senate Finance Committee Leaders Introduce AFIRM Act to Address Medicare Appeals Backlog

by King & Spalding on

On December 8, 2015, Senate Finance Committee Chairman Orrin Hatch (R-Utah) and ranking member Ron Wyden (D-Ore.) introduced the Audit & Appeals Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 (S. 2368). ...more

AGG Helps Hospice Weather the Perfect Storm of Aggressive Medicare Payment Denials and Administrative Appeal Backlog

by Arnall Golden Gregory LLP on

Medicare’s implementation of post-payment review through private contractors who are overly aggressive in denying payments, combined with a severe backlog of cases in queue for hearing before an Administrative Law Judge...more

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