Medicare Appeals

Congress, we must reform Medicare appeals

Congress, we must reform Medicare appeals

Ten years - that's how long the U.S. Department of Health and Human Services Office of Medicare Hearings and Appeals estimates the Medicare appeals backlog of 750,000 cases will take to clear.

Judge reverses Medicare appeal ruling in inpatient rehab case

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A federal District Court in Louisiana has reversed a Medicare Appeals Council ruling over denials for rehabilitation claims, including one involving an assisted living resident.

House leader urges HHS to end settlements meant to cut Medicare backlog

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The Department of Health and Human Services may not have had the authority to offer providers special settlements to help clear a huge backlog of Medicare appeals, a leading Congressman said in a recent letter to the agency. Rep. Kevin Brady (R-TX) is urging HHS to halt the new settlement process.

High-profile consumer advocacy group sues over broken Medicare appeals process

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Long-term care providers have been outspoken in their criticism of the Medicare appeals process, which has all but ground to a halt. Now a class-action lawsuit says Medicare beneficiaries also are being harmed by the excessively long delays.

Congress grills top judge on appeals jam backlog

Congress grills top judge on appeals jam backlog

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There is no easy fix to the staggering backlog of Medicare appeals, a government official said during a July 10 Congressional hearing.

CMS announces Medicare appeals without administrative law judge hearings

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Long-term care providers will be able to appeal certain Medicare claims decisions without going through an administrative law judge hearing, the Office of Medicare Hearings and Appeals (OMHA) announced Thursday.

Medicare claims reviews should be more streamlined, government report states

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The government could improve Medicare oversight by creating a more uniform and unified post-payment review system, according to a report from federal officials.

Extrapolation for overpays OK, court says

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A federal appeals court has ruled that a government contractor may justifiably calculate the amount a provider owes for Medicare overpayments by conducting a limited audit and then extrapolating from those findings.