VNAA Attends OMHA Forum Regarding Appeals Backlog
Tuesday, February 18, 2014
by: VNAA Policy Team

Section: Public Policy and Advocacy

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On Feb. 12, VNAA attended the Department of Health and Human Services’ Office of Medicare Hearings and Appeals (OMHA) Forum regarding the growing backlog of appeal claims awaiting hearing by an administrative law judge (ALJ). OMHA organized the forum to provide transparency on the growing backlog of appealed claims.
OMHA staff discussed initiatives to streamline the process of filing an appeal, including a future electronic appeals system and offered suggestions on how providers can format their appeals to make the process more efficient. VNAA agrees that reform is needed in the appeals system, but the Centers for Medicare and Medicaid Services (CMS) must also address the high level of inaccurate denials faced by home health agencies at level one and two. OMHA hears appeals at level three, prior to appeals being sent to OMHA appeals are heard and processed at CMS by Quality Independent Contractors (QICs). CMS needs to examine the most common denials that are overturned by an ALJ and provide additional education to its Recovery Audit Contractors to avoid inappropriate denials in the first place.
OMHA gave several reasons for the cause of backlog, attributing the delays to a huge workload in FY 2013--a workload that more than tripled appeals seen in previous years. This workload caused mail and processing delays (i.e. entering cases manually into the database) and slow case assignment as a result of full dockets for Administrative Law Judges. OMHA also provided suggestions to appellants to help move the appeals process along. Each section at the forum provided tips for appellants, including an administrative law judge panel that provided do’s and don’ts for appellants awaiting hearing. Lastly, OMHA also went over plans for the future, from rolling out a new appeals website in the spring of 2014 to a fully electronic appeals process that could be available in 2015 or 2016.
Read the OMHA forum brochure here. View the presentations from the forum here.  Read VNAA's letter here
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