OMHA pilots appeals program

Thursday, July 10, 2014

WASHINGTON – The Office of Medicare Hearings and Appeals (OMHA) has announced a pilot program aimed at helping providers resolve claims appealed to the administrative law judge (ALJ) level.

The OMHA earlier this year held a hearing to address the huge backlog of appeals at the ALJ level.

To qualify for the program, a provider must have a minimum of 20 claims or $10,000 tied up in appeals. The amount of each claim must be less than $100,000. 

Other requirements of eligibility: Claims must have been filed in 2013 and can’t be currently assigned to an ALJ, and providers must appeal all claims for the same service, according to an AAHomecare bulletin.

The program will rely on a settlement conference facilitator to mediate between providers and CMS. The facilitator does not make official determinations, but may help the appellant and CMS see the relative strengths and weaknesses of their positions, according to the U.S. Department of Health and Human Services website.