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BC Advantage - 2018 Issue 1

The Medicare Appeals Adjudication Backlog New Initiatives May Offer Relief to Appellants

As appellants with pending Medicare appeals are acutely aware, there exists a significant backlog of pending appeals, which has greatly delayed final adjudication of hundreds of thousands of appeals. Section 1869 of the Social Security Act (42 U.S.C. § 1395ff) (the Act) sets forth the five-stage uniform appeals process applied to Medicare Part A and Part B reimbursement appeals and establishes adjudication deadlines.   The Department of Health and Human Services (HHS) Office of Medicare Hearings and Appeals (OMHA) oversees the third stage of this process, i.e., the Administrative Law Judge (ALJ) hearing stage. ...

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