OMHA Proposes Pilot Program to Resolve Appeals

The Office of Medicare Hearings and Appeals (OMHA), in an effort to ease the vast backlog of Medicare payment appeals before it, recently proposed a new pilot program that would bring CMS and providers together to try to negotiate a resolution to the provider’s appeal.

Under the pilot, OMHA would facilitate deals between CMS and certain providers or suppliers. If a resolution gets reached, the case would be pulled from the administrative law judge (ALJ) docket, thereby reducing the Medicare appeals backlog. However, if a settlement could not be reached, the claims would go back into the ALJ system.

Break Away from the Static

Solving the Medicare appeals problem is a serious concern for CMS. Current Medicare payment appeals face a waiting period of 20-24 weeks before the new appeals are even entered into the system, and then up to another 28 months until an ALJ is assigned to the case.

Although the pilot appears to be a step in the right direction towards easing the backlog, some health experts believe that the pilot program falls short of what is really needed.

As always, ADVOCATE will keep you updated on this and all issues impacting radiology as they become available.

Best regards,
Kirk Reinitz, CPA