Monday, July 11, 2016

CMS Proposes Changes to Improve the Medicare Appeals Process

Dianne De La Mare

The U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would make changes to the Medicare appeals process for payment and coverage determinations, Medicare beneficiary enrollment, entitlement determinations, and certain Medicare premium appeals.

According to the HHS press release, the proposed rule is designed to “address the unprecedented and sustained increase in the number of appeals and to eliminate the backlog of appeals currently pending at the Office of Medicare Hearings and Appeals (OMHA) and the Departmental Appeals Board (DAB).”

Specifically, CMS proposes additional administrative actions to expand the pool of available OMHA adjudicators, increase decision-making consistency among the levels of appeal, and improve efficiency by streamlining the appeals process so adjudicators and parties spend less time on repetitive issues and procedural matters. AHCA plans to submit formal comments, which are due on August 29, 2016, and welcomes comments and feedback from the membership.

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