News-At-A-Glance: Don’t Expect to Get a Level-Three Appeal Resolved Any Time Soon:

Most appeals that reach the third level in the appeals process may be delayed up to 28 months according to a notice posted by the Health and Human Services Office of Medical Hearings and Appeals (OMHA) on its Web site due to the overwhelming number of receipts and the existing workload within the agency. Appeals submitted after July 15 will be entered into the agency’s case processing system and then held until they can be accommodated on an administrative law judge’s (ALJ) docket for adjudication. An average 191 days are required for the appeal to be adjudicated by the ALJ. OMHA says that even though they are processing a record number of cases, they are receiving more than they can handle. This is likely due to the activities of Centers for Medicare and Medicaid Services auditing subcontractors and the resulting number of denials and demands for refunds. The number of appeals will correspondingly increase. Laboratories that have active appeals submitted after July 15 or are considering appeals now should take this delay into account and try to overturn denials in the redetermination and reconsideration part of the appeals process.