OMHA announces two pilot programs to reduce the backlog of appeals of Medicare claim denials

To reduce the backlog of appeals of Medicare claim denials, the Office of Medicare Hearings and Appeals (OMHA) announced two pilot programs on June 30, Nancy Griswold, OMHA’s chief administrative law judge, said at a July 10 hearing held by the House Committee on Oversight and Government Reform’s Subcommittee on Energy Policy, Health Care and Entitlements. One pilot allows providers to “have their claims adjudicated using statistical sampling and extrapolation. This initiative facilitates resolution of large numbers of claims based upon resolution of a statistically valid sample,” she said. The other pilot offers providers an alternative dispute resolution process with OMHA attorneys who have mediation training. If the pilots are successful, OMHA will roll them out nationally.