{"id":34722,"date":"2016-07-23T12:48:41","date_gmt":"2016-07-23T16:48:41","guid":{"rendered":"https:\/\/www.smart-union.org\/?p=34722"},"modified":"2016-07-23T12:48:41","modified_gmt":"2016-07-23T16:48:41","slug":"attention-retirees-significant-delays-medicare-appeals","status":"publish","type":"post","link":"https:\/\/www.smart-union.org\/attention-retirees-significant-delays-medicare-appeals\/","title":{"rendered":"Attention retirees: significant delays in Medicare appeals","gt_translate_keys":[{"key":"rendered","format":"text"}]},"content":{"rendered":"

\"Palmetto_rgb_web\"It\u2019s been on the news, and you may have heard about it: the Medicare appeals process is taking longer, specifically, at the Administrative Law Judge (ALJ) level. This article explains the five levels of appeals and provides information about the wait times for an ALJ hearing.
\n 
\nTo begin, let\u2019s look at the Medicare appeals process. The five levels are:<\/p>\n

    \n
  1. Redetermination (first-level, performed at Railroad Medicare or your local Medicare Administrative Contractor for part A or durable medical products claims)<\/li>\n
  2. Reconsideration (second-level, performed by a Qualified Independent Contractor\/QIC)<\/li>\n
  3. Hearing before an Administrative Law Judge or ALJ (which are independent from Medicare and are governed by the US Department of Health & Human Services (HHS))<\/li>\n
  4. Review by the Medicare Appeals Council<\/li>\n
  5. Judicial review in the U.S. District Court<\/li>\n<\/ol>\n

    Each level of appeal has certain timeliness standards. For a redetermination and reconsideration, contractors have 60 days to process an appeal request. For a third-level appeal, the guideline is the ALJ will generally conduct a hearing and render a decision within 90 days of the receipt of the hearing request. However, backlogs at the ALJ level are causing appeals to be processed, on average, in 819.4 days for Fiscal Year 2016 (from October 2015 to the present).
    \nThis problem with the untimely processing of appeals at the ALJ level is not new; however, the growing wait time has risen greatly since Fiscal Year (FY) 2012. The following trends show the average wait times by day at the ALJ level:<\/p>\n