'Patience is wearing thin' on Medicare appeals backlog, long-term care leader says

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AHCA President and CEO Mark Parkinson
AHCA President and CEO Mark Parkinson

Long-term care advocates anxious about the stalled Medicare claim appeals process were not soothed after a forum with government officials Wednesday.

“Our serious concerns remain,” said Mark Parkinson, CEO and president of the American Health Care Association/National Center for Assisted Living. “Unless policy and process improvements are introduced soon, the appeals process will become even more dysfunctional.”

Last month, providers learned that new appeals to administrative law judges would not be heard for at least two years. The administrative law judge is the third step in a five-step process to appeal decisions made by Medicare contractors or auditors.

The Office of Medicare Hearings and Appeals decided to stop assigning appeals to ALJs as of July 2013, OMHA stated in a memorandum. This is because the office has more than 460,000 appeals pending.

Providers argue that the huge backlog stems from a high volume of inappropriate claims denials from audits. If this issue is not addressed, or if OMHA does not receive additional resources to resume hearings, beneficiaries' access to nursing and therapy services could be “disrupted,” Parkinson said after Wednesday's forum.

OMHA representatives at the forum assured providers that the agency has more than doubled its productivity since 2009, according to an email about the event sent by AHCA/NCAL, the nation's largest long-term care provider association. Officials at the forum also reportedly said that the government will open up an additional office to help tackle this problem.

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