ALJ Delays by the Numbers

At a recent Office of Medicare Hearings and Appeals (OMHA) hearing on delays in scheduling appeals at the administrative law judge (ALJ) level, AAHomecare President Tom Ryan told OMHA Chief ALJ Nancy Griswold that when he hears stories of providers with patients who have been on oxygen for years being denied for technical reasons and having to appeal the denial to all the way to the ALJ level the entire audit process is broken.

Ryan advised Judge Griswold that HME providers “are in crisis mode.” He explained that OMHA’s long-term plans to use technology and other means to streamline and speed up the hearing process are welcomed by the industry. However, because the current system is dysfunctional on every level, providers need immediate relief. Ryan asked Griswold for solutions beyond legislation that would have an immediate impact. AAHomecare’s Audit Task Force is ready to work with OMHA and would like to schedule meetings in the near future.

Griswold said that the judges are still hearing cases, but that their workload has increased from 1,200 to 15,000 appeals per week since January 2012. An increase due to greater numbers of new Medicare beneficiaries was expected, but the size of the increase was not.

Current projections indicate an 18 to 22 week delay in entering (“docketing”) new requests into the ALJ case processing system, and the average processing time for appeals decided in fiscal year 2014 is 321.6 days.

Judge Griswold encourages providers to continue filing appeals despite the long delays, and recommends using the following steps:

  • • File your request for hearing just once.
  • • Hold the extra paper, exhibits, etc. until the case has been assigned to a specific judge.
  • • Check the ALJ website for processing times and delays.

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