HHS issues rule that speeds up appeals

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A Department of Health and Human Services final rule may allow providers to move more quickly through the backlog of 700,000-plus Medicare-related appeals.

From fiscal year 2009 to 2014, requests for an administrative law judge hearing through the Office of Medicare Hearings and Appeals rose 1,222%, according to the rule issued in January.

Administration officials say that's due to expansion of those who qualify for Medicare, enhanced monitoring of payment accuracy in Medicare Parts A and B, growth in appeals from state Medicaid agencies for dual eligibles and national implementation of the Recovery Audit Program.

Originally proposed in June, the rule would include expanding the pool of Office of Medicare Hearings and Appeals adjudicators and streamlining the appeals process so that less time is spent on “repetitive issues and procedural matters.”

An attorney adjudicator would be a licensed attorney employed by OMHA with knowledge of Medicare coverage, who is authorized to make decisions on requests for ALJ hearings and reviews of QIC [Qualified Independent Contractor] dismissals.