Average Audit Appeal Processing Time Surges to 714 Days

AAHomcare analysis shows a whopping 2122% increase in DMEPOS-related audit appeals over past 8 years.

In the first half of 2015, the wait time for Medicare claims audit appeals to be processed has increased by nearly 25 percent, with June posting an average processing time of 714.9 days, according to the American Association for Homecare.

Yesterday, AAhomecare released an analysis of the backlog at CMS’s Office of Medicare Hearing and Appeals (OMHA). The data can be found on the OMHA website at www.hhs.gov/omha/Data/index.html.

“It is painfully obvious that this system is broken, but no measures are being taken to fix the root of the problem,” said Kim Brummett, vice president of regulatory affairs at AAHomecare. “DMEPOS claims are different, and need to be treated as such. Home medical equipment providers are dealing with the same patient and same service/item on an ongoing basis over a period of time.

“When the first claim is denied, all of the subsequent claims for the same patient and service are denied,” Brummett explained. “However, when the previous claim is overturned, it does not mean that any other claims for the same patient and same service will be paid/overturned at any level. This cycle traps a large volume of claims in a system that cannot handle them properly.” 

All told, there the number of DMEPOS audits being appealed at OMHA has skyrocketed since 2006. Some key issues uncovered by AAHomecare’s analysis:

  • In CMS’s fiscal year 2006, there were 6,305 DMEPOS appeals at the ALJ. By fiscal year 2014, there were 133,839 appeals. This marked an astonishing 2122 percent increase over eight years.
  • On average, between fiscal year 2006 and 2014, DMEPOS appeals have accounted for 25 percent of the total appeals that have risen to the level of being heard by an administrative law judge (ALJ).
  • Within the first half of fiscal year 2014, there were 289,000 appeals at the ALJ level, which constitutes approximately 75 percent of the total number of appeals that were at the ALJ in fiscal year 2013.

For charts and more analysis from AAHomcare, visit bit.ly/auditbackloganalysis.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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