The Office of Medicare Hearing and Appeals (OMHA) administers the third level of Medicare appeals. OHMA has shared with AAHomecare in a recent meeting that they are well on track to remove the Administrative Law Judge (ALJ) backlog by the end of this year. In addition, OMHA shared data on the pending appeals. OMHA’s data shows a significant drop in the number of pending appeals. As of the end of 2021, OMHA had about 60,000 pending appeals, which is about a 90% decrease from the number of appeals waiting a hearing in 2017. However, the data continues to show that DMEPOS appeals still makes up over 50% of total pending appeals.
NUMBER AND PERCENT BREAKDOWN OF DMEPOS ALJ APPEALS |
|||||
|
2017 |
2018 |
2019 |
2020 |
2021 |
TOTAL DMEPOS APPEALS |
291,047 |
276,285 |
172,900 |
74,895 |
35,217 |
TOTAL OUTSTANDING APPEALS |
578,583 |
494,490 |
292,517 |
165,263 |
60,062 |
% Of DMEPOS APPEALS |
50% |
56% |
59% |
45% |
59% |
You can find AAHomecare’s ALJ appeals analysis one-pager here.