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Workload Information and Statistics

Although OMHA is processing a record number of Medicare appeals, we continue to receive more requests for hearing than our Administrative Law Judges can adjudicate in a timely manner. OMHA remains committed to processing requests for hearing in the order received as quickly as possible given pending requests and adjudicatory resources. In addition, we continue to process Part D prescription drug denial cases that qualify for expedited status within 10 days and screen all incoming requests to ensure Medicare beneficiary issues are prioritized given they often present emergent circumstances that must be promptly addressed. Beneficiary requests for hearing submitted to the “Beneficiary Mail Stop” are entered into the OMHA case tracking system (“docketed”) upon receipt.

In all other circumstances, you (or your representative) will receive an Acknowledgement of Request letter after your request is entered into the OMHA case tracking system. As of September 2015, new non-beneficiary requests are being processed and entered in into the OMHA case tracking system in an average of approximately 3 weeks after receipt (however, please note that requests with missing information may take additional time).  After the request is entered into the OMHA case tracking system it may take up to an additional week to display in OMHA’s ALJ Appeal Status Information System (AASIS).  To check on the status of your appeal, you may access AASIS at http://aasis.omha.hhs.gov/.  If your appeal does not display in AASIS within 6 weeks after you sent it to us, please contact us at 1-855-556-8475.

Decision Statistics

Appeals FY12 FY13 FY14 FY15 FY16
(Data through June 2016)
Fully Favorable 53.2% 44.3% 36.7% 33.6% 26.2%
Partially Favorable 6.4% 5.2% 2.8% 3.1% 1.9%
Unfavorable 27.9% 25.5% 30.1% 37.5% 43.7%
Dismissed 12.5% 25.0% 30.4% 25.8% 28.2%
Claims FY12 FY13 FY14 FY15 FY16
(Data through June 2016)
Fully Favorable 33.8% 35.1% 28.4% 18.4% 8.1%
Partially Favorable 16.4% 11.6% 11.5% 6.2% 2.0%
Unfavorable 34.1% 28.6% 31.4% 23.2% 13.0%
Dismissed 15.7% 24.7% 28.7% 52.2% 76.9%

*Includes appeals decided in the listed fiscal year
**Run Date: Jul 18, 2016

Average Processing Time By Fiscal Year

Fiscal Year Number of Days
FY09 94.9
FY10 109.6
FY11 121.3
FY12 134.5
FY13 220.7
FY14 414.8 
FY15 661.1
FY16 Average 848.8
     FY16 1st Qtr      795.8
     FY16 2nd Qtr      860.7
     FY16 3rd Qtr      935.4
Content created by Office of Medicare Hearings and Appeals (OMHA)
Content last reviewed on July 25, 2016