Medicare Financial Management Manual (Pub. 100-06), Ch. 6 § 100.3
Part B Hearing Results
100.3 – Section B – Part B Hearing Results
(Rev. 45, 05-28-04)
Section B deals with data on Part B hearings completed during the month. Base data shown on
actual counts of each activity and not derived from sampling or other estimating techniques.
HEARINGS FALL INTO THE FOLLOWING CATEGORIES:
Column (1)
On-the-Record with No Subsequent Hearing.--Include in column 1 hearings
held where the appellant originally requested an OTR hearing, indicates that
he/she is satisfied with the OTR decision, that he/she wishes to proceed with
an ALJ hearing (if the amount in controversy is $500 or more), or fails to
respond to the OTR within the required time frame. In addition, if the
appellant requests an in-person or telephone hearing subsequent to an OTR
decision, but the hearing is dismissed or withdrawn, include it here and not in
columns (2) or (3).
Column (2)
All Telephone.--Include in column 2, hearings where the appellant requested
and had a telephone hearing subsequent to an OTR hearing decision, or a
telephone hearing was held without a prior OTR decision. Count all telephone
hearings including those where the appellant did not follow-up timely to the
OTR notice, but later requested a telephone hearing.
Column (3)
All In-Person.--Include in column 3 hearings where the appellant requested
and had an in-person hearing subsequent to an OTR hearing decision, or an in-
person hearing was held without a prior OTR decision. Count all in-person
hearings including those where the appellant did not follow-up timely to the
OTR notice but later requested an in-person hearing.
Column (4)
Number in 120 Days.--For the total cases included in line 47, columns 2 and 3,
(e.g., the sum) show for lines 49-51 the numbers that were completed within
120 days of receipt. Use the methodology shown above the explanation for
line 13 to determine the completion date. Where an OTR decision is made and
the appellant chooses to not follow-up timely and later requests either an in-
person or telephone hearing, completion time for this second reported hearing
is measured from the date of receipt of original request to the date of the
second decision. If the appellant does not appear, dismiss the hearing in
accordance with §3794.3k, and use the date of notice of dismissal as your date
completed.
Line 45. Reversals.--Under the appropriate columns, show the number of OTR, telephone, and in-
person hearings completed in the month in which at least part of the review determination was
reversed i.e., a change was made and some, or all, of the new determination was in favor of the
appellant. (See the definition for line 11.)
Line 46. Affirmations.--Under the appropriate columns, show the number of OTR, telephone, and
in-person hearings completed in the month in which the review determination was completely
upheld, i.e., no change was made. All parts of all claims must be upheld in order for the case to be
counted as an affirmation. (See the definition for line 9.)
Line 47. Total Decisions.--Show the total number of hearing decisions completed during the
month that resulted in a reversal or affirmation, excluding dismissals and withdrawals.
Line 48. Number in 120 Days.--For cases included in line 47, show the number that were
completed within 120 days of receipt. See methodology for column 4 to determine the completion
date.
Line 49. No Previous OTR Held.--For cases included in line 47, columns (2) and (3), report the
number where you held the telephone or in-person hearing without first making an OTR decision,
i.e., the OTR hearing was bypassed.
In column (4), report the number of cases included in either column (2) or (3) which were
completed within 120 days.
Line 50. Previous OTR Counted.--For the cases included in line 47, columns (2) and (3), report
the number where you included the OTR count on a previous report. In column (4), report the
number of cases included in either column (2) or (3) that were completed within 120 days.
Cases reported in line 50 are those where an OTR decision was made and the appellant either
accepted the OTR decision, did not respond timely, or decided to go directly from the OTR
decision to an ALJ hearing. Then, subsequent to this OTR decision "acceptance," the appellant
changed his/her mind and decided that he/she wanted a telephone or in-person hearing. Do not
include these cases in line 6.
Line 51. Previous OTR Not Counted.--For cases included in line 47, columns (2) and (3), report
the number where you did not include the OTR count on a previous report. These are cases where
you made the OTR decision first, and the appellant indicated in a timely fashion (see §3794.9) that
he/she wanted a telephone or in-person hearing. In column (4), report the number of cases
included in either column (2) or (3) that were completed within 120 days.