Performance Improvement 2009. Do Medicare Administrative Law Judges Hold Timely Hearings?


This study assessed the use of telephone, video teleconference, and in-person hearings to decide Medicare administrative law judge cases and the timeliness of decisions during the first 13 months of operation of the Office of Medicare Hearings and Appeal (OMHA). Medicare beneficiaries, providers, and suppliers of health care services can appeal decisions about their Medicare claims.

OMHA held approximately three-quarters of its hearings by telephone during its first 13 months. Most sampled appellants were satisfied with their hearing format. Incomplete and inaccurate data limited the ability to manage the caseload. A number of cases were not decided in a timely manner. Fifteen percent of the cases that had a 90-day requirement and a decision date in the appeals system were not decided on time. A training program was implemented for staff to standardize the scheduling process and performs random unannounced screenings of the scheduling procedures and has modified the appeals system to record and track the requested and hearing formats. Steps have been taken to address technical difficulties associated with telephone and video teleconference hearings.

Report Title: Medicare Administrative Law Judge Hearings: Early Implementation, 2005-2006
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact: Erin Lemire, 202-205-9523
Performer: Staff; Office of Inspector General
PIC ID: 8979

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"PerformanceImprovement2009.pdf" (pdf, 1.26Mb)

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