Medicare appeals process worries providers and CMS alike

The Medicare appeals backlog has become an intractable problem, troubling not only providers, but also administrative law judges (ALJs) and others within the Centers for Medicare & Medicaid Services (CMS). In December 2013, the Office of Medicare Hearings and Appeals (OMHA) suspended assignment of most new requests for ALJ hearings, which means it will take at least 30 months for an ALJ to adjudicate a newly submitted appeal of a Medicare claim denial. The problems inherent in the Medicare appeals system are beyond the control of providers and require action by OMHA and CMS.