ALJ Appeals Backlog Continues Decline

OMHA reports to AAHomecare that within a year, the number of pending DMEPOS appeals fell by 51 percent.

The Office of Medicare Hearings and Appeals (OMHA) recently reported that the backlog of audit appeals waiting to be assigned to Administrative Law Judges (ALJs) has declined considerably.

As many DMEPOS suppliers and other Medicare stakeholders know, the delay got so bad that in 2018 a federal judge federal court judge in the U.S. District Court for the District of Columbia granted a motion for summary judgment requiring OMHA to eliminate the ALJ backlog by 2022.

Last week, representatives of the American Association for Homecare met with OMHA, which reported it is working at full capacity, and that as of Oct. 31, there were approximately 85,000 DMEPOS appeals pending at the ALJ, representing a 51 percent reduction over the past year.

A breakdown of the reduction in backlog over the past few years:

Year

Pending
DMEPOS Appeals

2017

291,047

2018

276,285

2019

172,900

2020,
as of Oct. 31

85,067

However, while OMHA is making progress, it is important to note that the average wait time to have an ALJ assigned to an appeal is just shy of four years (1,447 days), which is far beyond its 90-day target for appeals processing time. This lengthy delay is because the ALJ is still working through its backlog of cases on a first-come, first-served basis. By comparison, the OMHA appeal processing time in 2009 was 94 days, according to OMHA’s year-by-year breakdown of appeal processing time.

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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