News Release

HHS to Launch Changed Medicare Appeals Process

New procedures mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 will soon offer quicker resolution to appeals by Medicare beneficiaries, providers and suppliers.

The Medicare hearings function, currently handled by the Social Security Administration (SSA), will transition on July 1, 2005 to the Office of Medicare Hearings and Appeals (OMHA) located within the Department of Health and Human Services (HHS). The changes will help ensure that fee-for-service Medicare claims appeals are resolved within the 90-day timeframe mandated by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA).

"As HHS assumes responsibility for handling Medicare hearings, we are committed to making the appeals process better, faster and more convenient for seniors and other people with Medicare," HHS Secretary Mike Leavitt said. "Our goal is to eliminate the need for an aged or disabled beneficiary to travel if other resources are available closer to home."

HHS anticipates it can reduce hearing timeframes to comply with the BIPA requirements by using video teleconferencing technology (VTC) with a state-of-the-art electronic hearings process to provide significantly more access points than currently exist. HHS has access to VTC sites in over 1,000 cities nationwide. Both VTC and in-person hearings will be offered as appropriate to best meet the needs of all parties. To the extent that an in-person hearing is required, that hearing will be granted in the location most convenient to the parties. HHS Administrative Law Judges will travel to various locations around the country to conduct in-person hearings, as needed, which may include the use of local government facilities or other available sites.

More information on the new Medicare appeals function is available from OMHA Web site at www.hhs.gov/omha.