Forum Announced to Address Medicare Appeals Backlog

The Office of Medicare Hearings and Appeals (OMHA) recently announced that it will host a second OMHA Medicare Appellant Forum on October 29, 2014.  The forum will provide updates on OMHA and CMS initiatives designed to mitigate the backlog of Medicare Appeals at the ALJ level of appeal. The forum will be held on Wednesday, October 29, 2014 from 10 AM to 3 PM EST.  The forum can be attended in-person or via webinar. 

CMS Proposes Settlement Option to Resolve Patient Status Claim Denials Pending in the Medicare Appeals Process

On August 29, 2014, CMS announced it will offer “an administrative agreement to any hospital willing to withdraw their pending appeals in exchange for timely partial payment (68% of the net allowable amount)”, in an effort to quickly reduce the volume of inpatient claim denials pending in the Medicare appeals process. Currently, Acute Care Hospitals (including those paid via Prospective Payment System (PPS), Periodic Interim Payments (PIP), and Maryland waiver; as well as Critical Access Hospitals are eligible to submit… Read More >

GAO Report Identified Problems with CMS Contractors’ Postpayment Review Procedures

A recent report released by the Government Accountability Office (GAO) uncovered numerous issues related to the Center for Medicare & Medicaid Services” (CMS) general lack of oversight of its multiple contractors who conduct prepayment reviews. The GAO noted that these issues could lead to duplicate reviews and increased burdens for health care providers. The GAO report noted that 83% of all postpayment claim reviews were conducted by Recovery Auditors (RAs) formerly referred to as Recovery Audit Contractors (RACs). The remaining… Read More >

Senate Report Finds Medicare Audit Programs Have Failed to Reduce Improper Payment Rate

The Senate Special Committee on Aging recently issued a report addressing the current Medicare audit programs, the impact of these programs on reducing improper payment rates and the burden providers face when undergoing a Medicare audit. The report outlines inefficiencies related to the lack of coordination among the audit contractors and the failure to effectively target problem providers or problem areas. The report notes that in fiscal year (FY) 2013, CMS reported an estimated $50 billion in Medicare fee-for-service improper… Read More >