Medicare Payment Appeals on Hold
The Office of Medicare Hearings and Appeals, which is overwhelmed, has decided to bring the cases filed by beneficiaries to the front of the line. That means appeals by hospitals, nursing homes, doctors and other health-care providers could be on hold for two years.
The office has a backload of nearly 357,000 claims, according to a memo sent by the office's chief judge to health care associations, as Kaiser Health News reports. The memo said the agency has seen its caseload soar 184 percent over the past three years, while the number of administrative law judges has remained about the same.
The glut follows Medicare's decision to hire private auditors to comb through cases and find over-billing. Hospitals say that since auditors get a bonus when they flag a case, they have an incentive to over-do it.
Indeed, a 2012 investigation by the inspector general of Health and Human Services found that judges reversed payment denials 72 percent of the time for hospital care. Beneficiaries had only a 28 percent rate of reversal.
The American Hospital Association said it would make more sense to halt the audits of hospital claims while the backlog is being addressed. AHA also said the federal agency is breaking a law that requires a decision on appeals to be rendered within 90 days.
Meanwhile, consumer advocates say beneficiaries have had to wait as long as two years for a hearing and another nine months for a decision. Sometimes they die before the process is over.