HHS could change Medicare appeals rule

According to one proposal, the HHS could make significant cuts to its rate of appeals per year.

A new proposal would address the way the Department of Health and Human Services handles appeals cases. According to Kaiser Health News, the series of changes suggested would aim to rid the Department of its long case backlog within the next five years. The source quoted the Chief Law Judge of the Office of Medicare Hearings and Appeals, Nancy Griswold, who said that the current backlog would take 11 years to process under the current system.

Some of these changes would address Medicare Appeals Council decisions as well as the process for setting minimum appeal fees. The ultimate result is meant to encourage a smoother functioning system, the source said. The proposal is currently open to public comments, which are due by August 29.

Becker's Hospital CFO supplied some addition information about this option: More than 750,000 HHS appeals were pending as of April 30, and some of the impact from the proposal would potentially drive down the number of appeals per year by about 23,650.

This new deliberation comes after recommendations from the Government Accountability Office to HHS. Earlier last month, the GAO noted in a report that the amount of Level 3 appeals increased by 936 percent between the 2010 and 2014 fiscal years.

It also acknowledged that the actions HHS agencies have taken to lower the number of appeals in recent years. Despite this, the GAO recommended that HHS handle appeals and repetitious claims more efficiently. Medicare handled 1.2 billion FFS claims in 2014 alone, the report summary said.

Healthcare consulting firms will help organizations address their own inefficiencies. Contact LW Consulting and learn about the custom services we can offer practices, organizations and independent physicians.

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