DMEPOS Accounts for Half of ALJ Appeals

The number of audit appeal being escalated to ALJs has skyrocketed over the past fiscal year.

• By David Kopf
• Oct 19, 2017

The total number of appeals at CMS’s Office of Medicare Hearings and Appeals (OMHA) has exploded by 300 percent within this past year, with half of them being for DMEPOS claims, according to the American Association Homecare.

A total of 184,240 appeals sat at the Administrative Law Judge (ALJ) level at OMHA in FY2016, but by August of 2017 that number had ballooned to 591,962 appeals. 

Moreover, as of last week, 291,047 of those ALJ-level appeals were for DMEPOS claims, an AAHomecare statement noted. Assuming that the tally of appeals was static from August’s total, this would mean DMEPOS appeals comprised 49 percent of that total.

That percentage would be consistent with audit totals from FY2015 and FY2016, in which DMEPOS accounted for 49 percent of ALJ-level appeals, as well, AAHomecare noted.