The U.S. Senate Finance Committee held a hearing on how to make the Medicare audits and appeals process more efficient. Currently, the Medicare appeals system is backlogged with at least 500,000 cases pending review. During the hearing, Senators heard testimony from three witness – each representing a different level of appeal.
Some Senate members raised concern about the fact that the majority of payment appeals are found in favor of the defendant. High rates of reversals, they said, raises questions about “how the initial decisions are being made and whether providers and beneficiaries are facing undue burdens on the front end.”
“In its 2015 Regulatory Blueprint for Action, the National Association for Home Care & Hospice (NAHC) provides recommendations to eliminate delays in Medicare Appeals to ALJs. NAHC recommends that: 1) CMS take all necessary steps to improve the quality and accuracy of initial claim determinations to limit need for an administrative appeal; 2) CMS monitor its contractors that handle early-stage administrative appeals to ensure a high degree of accuracy and to reduce the number of appeals that end up before an ALJ; 3) CMS provide a settlement option to all appellants with claims pending before an ALJ in order to reduce the backlog. That settlement should be based on historical data on ALJ reversal rates and the cost savings achieved by Medicare coming through the avoidance of an ALJ appeal; 4) OMHA increase its resources to handle the level of demand and establish alternative dispute resolution processes to resolves some appeals.”
Click here to read more from NAHC.