An invitation from the Office of Medicare Hearings & Appeals (OMHA) brought representatives from the DME industry to Washington, D.C., on Feb. 12 to address ongoing concerns over Medicare audits.
The OMHA Appellant Forum was the result of the Administrative Law Judge’s (ALJ) decision in December to stop accepting most new appeals requests in order to deal with a backlog of 357,000 Medicare claims.
In making the announcement, Nancy J. Griswold, chief administrative law judge, said in a statement, “Due to the rapid and overwhelming increase in claim appeals, effective July 15, 2013, OMHA temporarily suspended the assignment of most new requests for an Administrative Law Judge hearing to allow OMHA to adjudicate appeals involving almost 357,000 claims for Medicare services and entitlements already assigned to its 65 Administrative Law Judges. This temporary measure was necessitated by a dramatic increase in the number of decisions being appealed to OMHA, the third level of administrative review in the Medicare claim and entitlement appeals process.”
In her memo, Griswold noted that the number of OMHA claims rose 184 percent in the last three years, while OMHA resources stayed relatively stable.
As a result of the announcement, OMHA invited stakeholders to its forum to discuss the situation and stakeholder concerns.
The VGM Group was among those encouraging industry professionals to participate, and the service organization also Tweeted live from the event to update those who couldn’t join the forum in person.
In a news announcement following the forum, VGM said Griswold and several other administrative law judges heard from “several DME representatives and VGM members who voiced their concerns about how audit inconsistencies are impacting business and service to beneficiaries.”
Among the issues discussed, VGM said, were why technical and clerical denials were being appealed at the ALJ level instead of being handled by contractors at a lower level.
VGM said Griswold “defended her processes, but noted the many concerns, and understood that the decisions are affecting business and beneficiaries.”
The VGM statement said at the time of the forum, the ALJ still had a backlog of 164,000 appeals.
According to the ALJ announcement, the appeals suspension was expected to last at least two years.
