Government asks for suggestions on how to reduce Medicare appeals backlog

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The federal government is asking the public to suggest ways of reducing Medicare appeals and cutting down on a backlog at the administrative law judge level. The request for information was filed by the Office of Medicare Hearings and Appeals and published in today's Federal Register.

Long-term care and other providers have lodged a huge number of appeals in recent years, after various government initiatives led to more claim denials. More aggressive activity by Recovery Audit Contractors in particular led to a surge in appeals starting in 2012, OMHA notes in its request for information. The RAC program essentially has been halted, with the government acknowledging that improvements have to be made.

In the meantime, OMHA has introduced two alternative routes for providers to resolve appeals. The agency is asking for feedback on these programs and suggestions for other ways to address the appeals backlog. OMHA also would like suggestions about how to revise current regulations to “streamline the adjudication process” while maintaining its integrity, according to the Federal Register document.

An electronic means of adjudicating cases is in the works, the document states.

Options for cutting down the backlog are “limited,” Chief Administrative Law Judge Nancy J. Griswold told Congressional lawmakers in July. Hiring temporary judges is not a viable solution, she noted.

Comments are being accepted electronically and by mail through Dec. 5.