HHS Suspends Medicare Appeals
In response to a growing backlog of Medicare appeals, the Department of Health and Human Services (HHS) announced measures to triage currently outstanding appeals with the majority of appeals processing being suspended for up to two years. HHS made the announcement in the Jan. 3, 2014 Federal Register Vol. 79, No. 2.
The main reason generally cited for the current problem is an approximately 184 percent increase in appeals stemming from increasing Recovery Audit Contractor activity, while the number of Administrative Law Judges (ALJs) to hear those appeals has remained unchanged at 65. The HHS Office of Medicare Hearings and Appeals (OMHA) is also holding an appellant forum to relay information on a number of OMHA initiatives designed to deal with the backlog and offer guidance on steps providers can take to mitigate the impact of the current problem. The OMHA Medicare Appellant Forum will be held on Wed., Feb. 12, 2014, with a check-in time of 9 a.m. at Cohen Auditorium of the Wilbur J. Cohen building located at 330 Independence Ave. SW., Washington, DC 20024. The registration deadline for the Forum is today, Jan. 28, 2014 (please refer to the Federal Register notice linked above for more details.)
The backlog and suspension in Medicare appeals processing is a serious concern from both a provider and beneficiary rights perspective. Given the fact that most of this backlog is the natural response to increased audit activity, HHS should suspend or scale back that audit activity until the infrastructure is in place to handle the overall process, including appeals. HHS estimates that since 2012 they have received over 136,000 appeals; this increase in volume constituting the main factor in creating the current backlog.
Provider associations and beneficiary rights activists are raising concern with HHS over the suspension. LeadingAge New York is interested in hearing from members who are experiencing hardship as a result of delays in Medicare appeals processing. There is also concern that the OMHA itself may be in violation of current Medicare statute which requires a 90-day turn around once a request for an ALJ hearing is filed.
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827