The Department of Health and Humans Services (HHS) recently reported that as of June 30, 2021, the backlog of Medicare appeals awaiting hearings before Administrative Law Judges (ALJs) at the Office of Medicare Hearings and Appeals (OMHA) is down to approximately 86,000 appeals. This represents a significant reduction (about 80%) in the number of appeals pending at OMHA as compared to the backlog they were experiencing in November 2018 (approximately 427,000 appeals).
In a lawsuit regarding the excessive delays in the appeal process for Medicare reimbursement claims, the United States District Court for the District of Columbia ordered HHS to clear the backlog by the end of fiscal year 2022. Based on the continued progress toward reducing the ALJ backlog, HHS seems likely to meet its target. This would finally bring relief to allergists and other providers who currently have Medicare claims pending before ALJs. The backlog elimination would only affect Medicare claims that have been appealed to the ALJ, which is the third level of the appeal. It would not impact audits or appeals pending before the Medicare Administrative Contractor or the Qualified Independent Contractor.
For more details regarding the status of the ALJ backlog, please refer to the Medicare Appeals Dashboard.
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