Monday, May 4, 2015

Senate Hearing on Medicare Audits and Appeals

Dianne De La Mare

In late April, the Senate Finance Committee held a hearing entitled, Creating a More Efficient and Level Playing Field: Audit and Appeals Issues in Medicare, focusing on much needed efficiency and increased effectiveness in the Medicare Appeals process. Committee Chairman, Orrin Hatch (R-UT) opened the hearing by stating that Medicare’s hiring of contractors to conduct audits of claims submitted to Medicare “has led to a seemingly insurmountable increase in appeals, with a current backlog of over 500,000 cases…which has resulted in long delays for beneficiaries and providers alike.”

Chairman Hatch also noted that “large portions of the initial payment determinations are reversed on appeal” and “such a high rate of reversals raise question about how the initial decisions are being made and whether providers and beneficiaries are facing undue burdens on the front end.” Ranking Member Ron Wyden (D-OR), and other witnesses also participated in the hearing, and discussed a number of measures that if considered would reduce the ineffectiveness of the current Medicare appeals process, while at the same time protecting program integrity.

The witnesses, who were largely federal government employees,  Medicare Administrative Contractor (MAC), CMS Qualified Independent Contractor (QIC) and Nancy Griswold, Chief Administrative Law Judge (ALJ), discussed a potential new filing fee for providers and the elimination of contingency fee payments for Medicare Recovery Auditors (RACs).

To see all the proceedings of the hearing go to

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