Wednesday, January 25, 2017

CMS Releases Final Rule Revising Medicare Appeals Process

Dianne De La Mare

The US Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) has released a final rule, Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures, that is part of HHS’s three-pronged approach for addressing the increasing number of Medicare appeals and the current backlog of claims waiting to be adjudicated.

The rule provides new provisions that will expand the pool of HHS, Office of Medicare Hearings and Appeals (OMHA) adjudicators; increase decision-making consistency among the levels of appeal; and improve efficiency by streamlining the appeals process so less time is spent by adjudicators and parties on repetitive issues and procedural matters; but will not solve the current backlog, according to HHS.

 See Chief Administrative Law Judge, Nancy Griswold, and Departmental Appeals Board Chair, Constance Tobias blog for more information at: AHCA/NCAL concur with the American Hospital Association’s (AHA) position that these small changes to the Medicare appeals process will not likely bring HHS any closer to clearing the current backlog.

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