Home Health & Hospice Week

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KNOW YOUR FACTS: ADMINISTRATIVE LAW JUDGE APPEALS

RAC appeals are running up ALJs' caseloads.

A crucial decision from an administrative law judge could make or break your reimbursement.Learn these important ALJ appeals facts:

• For cases not subject to the 90-day decision deadline, ALJs decided slightly more cases within six months -- 90 percent in 2008 versus 88 percent in 2005. But the decisions took slightly longer on average -- 119 days versus 110 days.

• One-third of ALJs' increased caseload, which has jumped 37 percent since 2005, is due to appeals related to Recovery Audit Contractors (RACs).

• ALJs are scheduling hearings more quickly than when they transitioned to the Department of Health and Human Services. It took 40 days from receiving a request for the ALJs to schedule a hearing in 2008, while it took 66 days in 2005. However, it took more time (six days) after scheduling to complete the hearing and issue a decision letter.

• ALJs decided cases subject to the 90-day deadline on an average of 69 days in 2008, compared to 82 days in 2005.

Source: HHS Office of Inspector General, "Medicare Administrative Law Judge Hearings: Update, 2007��"2008" (OEI-02-06-00111), www.oig.hhs.gov/oei/reports/oei-02-06-00111.pdf.