Home Health & Hospice Week

Hearings can now take place via video and telephone--but providers aren't happy.

It may be the season for traveling over the river and through the woods--but fortunately home health agencies and durable medical equipment providers won't have to travel far when appealing Medicare decisions before an administrative law judge.

"We are encouraging hearings over videoconferencing," attorney Rebecca Hirschorn of the Office of Medicare Hearings & Appeals announced during the Centers for Medicare & Medicaid Services' Nov. 17 Home Health, Hospice and DME Open Door For-um. "In addition, there are certain cases where the hearings take place over the telephone."

As of July 1, responsibility for third-level appeals before administrative law judges moved from the Social Security Administration to OMHA, which is located within the Department of Health & Human Services' Secretary's office. The Medicare Moderniza-tion Act of 2003 mandated the change (see Eli's HCW, Vol. XIV, No. 24).

Headquartered in Arlington, VA, OMHA has field offices in Cleveland, Miami and Irvine, CA, and an Arlington field office separate from the headquarters.

To simplify and speed up the appeals process, the department has contracted with videoconferencing providers across the country, Hirschorn reported. Each state has at least one videoconferencing facility for holding long-distance hearings, and some states have more. The technology permits multi-site participation, so a witness can testify from one state and appellants and counsel from another, she said.

An appellant may still request an in-person hearing, which will be granted upon the finding of good cause, according to the interim final rule on appeal process changes published in the Federal Register on March 8, 2005. However, the request constitutes a waiver of the 90-day time frame for holding a hearing and rendering an opinion.

Providers and their legal representatives have protested the switch to videoconference from in-person hearings (see Eli's HCW, Vol. XIV, No. 22). They contend that videoconference hearings will hamper communication and put providers at a disadvantage.

Social Security ALJs Phase Out

Hirschorn offered a quick overview of the revamped appeals system during the forum.

The first appeal still occurs at the carrier or fiscal intermediary level, while the second-level appeal--the "reconsideration"--is conducted by a Qualified Independent Contractor (QIC). The provider may then submit an appeal at the administrative law judge level.

The Social Security Administration's ALJs are currently wrapping up hearing requests filed before July 1, Hirschorn said. They had hoped to complete their caseloads by Oct. 1 but still have "quite a few" cases to finish, she noted.

Meanwhile, the OMHA ALJs are handling appeals filed after July 1. While the bulk of those are still coming from FIs and carriers, OMHA is beginning to see more appeals coming from the QICs, Hirschorn added. 

Note: Information on the Medicare appeals process is at www.hhs.gov/omha and www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3944.pdf.