{"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":"
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.
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\nTo begin, let\u2019s look at the Medicare appeals process. The five levels are:<\/p>\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
While the wait times average more than two years, HHS has been making beneficiary-submitted appeals a priority, \u201cgiven that they often present emergent circumstances that must be promptly addressed,\u201d as written on the Office of Medicare Hearings and Appeals (OMHA) Adjudication Timeframes webpage at http:\/\/www.hhs.gov\/omha\/important_notice_regarding_adjudication_timeframes.html<\/a>. 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. To begin, let\u2019s look at the Medicare appeals […]<\/p>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"author":6,"featured_media":27145,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","footnotes":""},"categories":[41,12,27,18],"tags":[3369,3370,572,928],"member_types":[],"acf":[],"yoast_head":"\n
\nIt\u2019s important to note that Medicare contractors, such as Palmetto GBA Railroad Medicare, do not have any connection to the ALJs and cannot assist in fast-tracking any appeals at the ALJ level.
\nFor more information on this issue, you can visit the OMHA website at http:\/\/www.hhs.gov\/omha<\/a>.
\nIf you have questions about your Medicare coverage, you may call Palmetto’s toll-free Beneficiary Customer Service Center at 800-833-4455, Monday through Friday, from 8:30 a.m. until 7 p.m. ET. For the hearing impaired, call TTY\/TDD at 877-566-3572. You are also encouraged to visit the Palmetto GBA Railroad Medicare website at www.PalmettoGBA.com\/RR\/ME<\/a> and their beneficiary Facebook page at www.Facebook.com\/MyRRMedicare<\/a>.<\/p>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"excerpt":{"rendered":"