A new proposal from the Department of Health and Human Services would alter the Medicare appeals process in an effort to trim the backlog of cases, which comprises more than 700,000 cases.
Without procedural changes, the current backlog would take 11 years to clear entirely even if there were no additional appeals filed, Nancy Griswold, the Office of Medicare Hearings and Appeals’ chief law judge, told Kaiser Health News. The new proposal would accelerate the decision-making process and send fewer cases to the third level of appeals, where they often linger for years.
Under the proposal and increased funding requested by HHS, the backlog would be cleared by 2021. The rule would also establish certain final decisions from the Medicare Appeals Council as precedents those at the lower levels would be bound to follow. It would also change the minimum amount required to lodge an appeal, which is currently $150, by using Medicare’s allowed amount rather than the amount billed by the provider.
Although the proposals make many changes industry groups have called for, many say it doesn’t go far enough. “We are skeptical that these proposals will do more than scratch the surface of the severe backlog in ... appeals that has led to hospitals facing multi-year waits for hearings,” said AHA Executive Vice President Tom Nickels. “We are deeply disappointed that HHS has not made more progress in addressing the delays despite the more than two years since the delays began.” Similarly, the establishment of precedents could be burdensome for Medicare patients seeking to claim their benefits, Alice Bers, an attorney with the Center for Medicare Advocacy, told KHN.
- here’s the proposed rule (.pdf)
- read the KHN article
- here’s the AHA statement