Tuesday, June 21, 2016

HHS' Efforts to Stem Medicare Appeals Backlog Not Enough

Dianne De La Mare 

The US Government Accountability Office (GAO) has released a report: Medicare Program: Continued Action Required to Address Weaknesses in Provider and Supplier Enrollment Controls, offering a bleak assessment of ongoing efforts to stem the mounting Medicare appeals backlog.

According to GAO, the “backlog shows no signs of abating as the number of incoming appeals to surpass adjudication capacity” at the end of the 3rd and 4th levels of the appeal.

Despite many interventions by Medicare officials, the number of appeals from health care providers and patients challenging denied claims continues to grow, which is only increasing the backlog of cases and delaying decisions well beyond the timeliness set out by the law.

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