AOPA addresses CMS on ALJ hearing suspension

The American Orthotic & Prosthetic Association has written a letter to CMS administrator Marilyn Tavenner requesting CMS to suspend all audits until CMS and the Department of Health and Human Services are able to make all administrative law judge hearings available within the statutory requirement of 90 days as passed by the Medicare, Medicaid and State Children’s Health Insurance Program Benefits Improvement and Protection Act of 2000.

Recently, the Office of Medicare Hearings and Appeals temporarily suspended the processing of any new administrative law judge (ALJ) hearings, a suspension which is expected to last for 2 years. The current wait time for an ALJ hearing has increased from 90 days to between 16 to 26 months, putting financial pressure on providers, negatively affecting amputees and other mobility-impaired patients and infringing on O&P providers’ statutory and due process rights.

“We can all agree that ensuring the health of Medicare beneficiaries is our priority,” Anita Liberman-Lampear, MA, president of AOPA, and Thomas F. Fise, executive director of AOPA, stated in their letter. “However, undermining the due process by which providers of health services resolve disputes over individual claims is not a sustainable solution to the burgeoning backlog of ALJ hearing requests, a backlog created by CMS’ overly aggressive audit policies.”

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