Following a January notice from the U.S. Department of Health and Human Services (HHS) that Medicare appeals could be delayed for more than two years, the AMA and nearly 100 other organizations called on the Office of Medicare Hearings and Appeals (OMHA) to remedy the appeals backlog.
In a letter sent Wednesday to OMHA, the medical societies expressed concern about the “multitude of issues that patients and physicians face when the Medicare appeals process is not working properly.”
OMHA suspended the assignment of new requests for administrative law judge hearings, citing a 184 percent increase in claims and entitlement workloads. OMHA noted in a presentation last week that the appeals backlog can be attributed in part to the continued expansion of Medicare’s audit programs. OMHA anticipates assignments of requests for hearings could be delayed for up to 28 months.
“By delaying the assignment of cases … by more than two years, OMHA is denying due process, which is predicated on the timely disposition of disputes for physicians and other providers who experience erroneous determinations by Medicare contractors,” the letter stated.
Meanwhile, nearly half of appealed determinations by recovery audit contractors (RAC) are overturned, the organizations pointed out. The AMA has continuously argued that the RAC program’s contingency fee structure creates an incentive for the auditors to conduct “fishing expeditions.” Most recently, the AMA has advocated for a penalty for contractors that make erroneous overpayment determinations.
“The OMHA appeals process is but one appeals process that physicians and patients must navigate,” the letter states. “We recommend that OMHA and the Office of the Secretary within the U.S. Department of Health & Human Services evaluate the need for expedient appeals processes across the health programs administered by HHS, including Medicare, Medicare Advantage and the Medicare Prescription Drug benefit.
“The numerous appeals requirements, actual costs of filing appeals and often lengthy delays undermine the ability of physicians to deliver patient-centered care.”
“With the numerous new regulatory requirements that physicians are facing today, physicians do not have the resources to navigate an interminable appeals process,” the letter states.
