The Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act is a bipartisan effort in the Senate to help with the current backlog in processing and adjudicating Medicare appeals, which is currently 587 days. The situation is so severe that the United States Court of Appeals for the District of Columbia Circuit has ordered a review to determine if the Department of Health and Human Services should be required to stick to the normal 90 day deadline for administrative law judge appeals.
The Senate bill would require an online portal to be built so the status of claims could be monitored. It would also create an ombudsman position to help educate providers about the process and clear up any problems. Most importantly, the bill would create new magistrates with the power to decide smaller claims, which would free up administrative law judges to more quickly hear larger appeals.
As the bill is on the Senate’s legislative agenda for this year the Congressional Budget Office has issued a report on it and determined that implementation would cost $1.7 billion over the first 10 years.
McKnight’s reported this story in "Bill to expedite Medicare appeals expected to cost $1.7 billion."
Despite the high costs of this bill, it is important to do something about the current length of Medicare appeals. Providers need to know what services will be paid so they can best treat their patients and avoid practices that might lead to a denial of coverage.
If the Senate does decide that this proposal is too costly, it can only be hoped that they quickly come up with a better one.
Reference: McKnight’s (Feb. 18, 2016) "Bill to expedite Medicare appeals expected to cost $1.7 billion."