HHS & OMHA
What is the birthday of OMHA?
July 1, 2005
Medicare Appeals System - it is used to process paper appeals
Provides administrative support to an ALJ team to ensure the timely and efficient adjudication of Medicare appeals.
Medicare Administrative Contractor - 1st level.
65
Two
1) The Office of Secretary ( including 15 staff divisions - OMHA is in this one)
2) 11 Operating Division (CMS is one)
What does ECAPE stand for and what is it used for?
Electronic Case Adjudication and Processing Environment. It is used to process electronic appeals.
Name three types of parties to an appeal.
Beneficiary
Supplier
Provider
Plan
What does QIC stand for and what level is it?
Qualified Independent Contractors - Level 2.
What are the services for a Medicare Part A claim?
Inpatient Hospital
Skilled Nursing Facility
Hospice Services
Inpatient Rehabilitation Facility
Home Health Services
What is OMHA"s Vision?
World class adjudication for the public good.
Where can you find the ECAPE Desk Guides?
In the ECAPE Home Screen.
What are the two types of representatives for an appeal?
Authorized
Appointed
Who processes all non-QIO appeals after the appeal is closed at Level 3 and what do they do with them?
AdQIC - they review the decision for any errors and process according to the appeal outcome.
What type of Medicare Plan would you need a formulary for?
Part D - Medicare Prescription Drug Program.
What are the two divisions within the office of operations?
Field Operations Division
Central Operations Division
What do you use to navigate through an ECAPE appeal to previous screens?
The Breadcrumb trail.
What is needed to go forward with an appeal if a beneficiary has passed away?
Substitution of Party
What does QIO mean and where do we get these from and where do you send them when they are done?
Quality Improvement Organization - they send these appeals directly to our office and we return it back to them when the decision is complete.
What does MSP stand for and what does it mean for a beneficiary?
Medicare Secondary Payer - Medicare pays the outstanding medical bill with the understanding that the beneficiary thru a settlement will reimburse Medicare. Example - wreck, workers comp, etc...
Which of the 11 Field Offices is a satellite office?
Seattle, Washington
What system do we use to record a hearing?
Avaya.
What are some of the things needed on an appointment of representation form?
Date
Signature
HICN
Statement
Name/Address/Phone number
What is the repository?
It is is a listing of all provider representatives, contacts and their addresses in ECAPE.
How are appeals assigned by and processed by in Central Operations to the field offices?
On a rotation basis, first in and first out basis.