A bipartisan bill that would create more resources and funding for the Medicare claims appeal process was introduced by Senate Finance Committee leaders this week.
The Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015 was formally introduced to the full Senate on Tuesday by Finance Committee Chairman Orrin Hatch (R-UT) and ranking member Ron Wyden (D-OR). The bill was first approved by the Finance Committee in June; it’s now been added to the Senate’s legislative calendar.
The bill would provide $125 million to the Office of Medicare Hearing and Appeals and $2 million to the Departmental Appeals Board of the Department of Health and Human Services for fiscal year 2016, and following fiscal years. The added funds would be used for reviews, hearings and appeals.
The measure also would establish a Medicare magistrate program, which would review claims appeals of values between $150 and $1,500. Appeals over $1,500 would be handled by administrative law judges.
The primary purpose of the proposal is to cut down the backlog of Medicare appeals claims, of which there are currently 900,000 pending at the Office of Medicare Hearings and Appeals, Hatch in comments to the Senate. Hatch also noted the wait time for claims to be processed has skyrocketed from 94 days in 2009, to 547 days in 2015.
“It takes, on average, a year and a half for Medicare beneficiaries — many of whom live on fixed incomes — filing an appeal to find out whether their services will be covered in the end,” Hatch said. “Let me clearly state, for the record, that we have neither the time, nor the money to play partisan games with this issue.”
In addition to the added funds and magistrate program, the bill would establish an online system for providers to track claims, require the Government Accountability Office to issue a report by the end of 2018 saying whether the increased funding helped alleviate the claims backlog; allow for sampling and extrapolation to be used in the appeals process; and establish an appeals resolution process where multiple claims on similar issues could be settled as a group.