In a status report published late last month, the Office of Medicare Hearings and Appeals (OMHA) revealed a reduction in the appeals backlog by 25%.
The OMHA has been actively working to reduce the appeals backlog, from a record high of 886,418 appeals pending an Administrative Law Judge (ALJ) Hearing in 2018. According to the status report, there were a total of 318,254 appeals pending for the reporting period ending June 30, 2019.
While the 25% reduction in pending appeals is positive, the average processing time for a case to be heard is still very long. While it has been our experience that the wait time from filing to hearing is averaging over four years, the OMHA's published average is just under that, at 1,361.7 days.
A review of decision statistics for Administrative Law Judge hearings shows that more than half of the appeals, or 56%, have resulted in a dismissal. 24.9% of ALJ Hearings received unfavorable decisions and only 16.4% of cases received fully favorable decisions.
The DME industry is still the largest contributor to the backlog, with about 54% of claims currently pending being DMEPOS.