Proposal to reduce Medicare appeals backlog won’t solve problem

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In a letter to HHS’ Office of Medicare Hearings and Appeals, the American Hospital Association said HHS’ recent proposal to reduce the Medicare appeals backlog at the administrative law judge level is likely “to do little more than scratch the surface of the problem.”

As part of the proposal, OMHA would reassign a portion of the appeals to non-ALJ adjudicators. HHS estimates that expanding the pool of adjudicators would reduce the total number of appeals sent to ALJs by about 23,650 per year.

“This is movement in the wrong direction, and it is clear that merely tweaking the appeals systems will not adequately address the problem,” wrote Ashley Thompson, AHA senior vice president for public policy and analysis.

A permanent solution to the appeals backlog requires HHS to implement controls to limit inappropriate claim denials by recovery audit contractors, according to the AHA.

Via AHA: Proposal to reduce Medicare appeals backlog won’t solve problem

 

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