Physicians soon will bring all Medicare appeals to HHS

The plan to take over the claims appeals process continues to cause consternation on Capitol Hill.

By David Glendinning, AMNews staff. Sept. 5, 2005.

Washington -- Physicians who decide to fight Medicare when they receive claims denials or overpayment charges may find it harder to get the government's attention.

The Dept. of Health and Human Services has started to take control of one key portion of the appeals process that had been the Social Security Administration's responsibility. By placing all four levels of appeals under HHS's bailiwick, federal officials say they will improve the government's response to people who have problems with their Medicare claims.

But government watchdogs say the move might cause more problems than it actually solves. The Government Accountability Office in a recent report identified several significant areas of concern with the HHS transition plan. Even if the department is able to finish taking the reins from Social Security by an Oct. 1 deadline, people challenging Medicare could discover that they have a harder time making their case to the government.

Hearing availability is a major point of contention for the GAO. Before the transition began, Medicare participants who took their denied claims appeals up to the third level of review were entitled to an in-person hearing before an administrative law judge at one of 141 offices the Social Security Administration maintained. Once HHS takes full control, only four offices will be available for hearings.

HHS has said it would make up for the difference by conducting hearings using videoconferencing technology and allowing appellants to make their cases from a remote location. But that alternative might be inadequate for some people, said GAO Health Care Director Leslie G. Aronovitz.