- HHS announced proposed changes Tuesday that aim to streamline the Medicare appeals process and reduce the number of pending appeals.
- Medicare officials estimated that if the changes are implemented, along with proposed funding increases and legislative actions requested in the president’s budget for FY 2017, that the backlog could be eliminated by FY 2021.
- The office has faced mounting criticism over the growing backlog, including a recent investigation from the Government Accountability Office, and some experts have expressed skepticism that its proposed changes would be sufficient, Kaiser Health News reported.
The need for a solution has grown as Medicare's appeals backlog has reached more than 700,000 cases. If nothing is changed, it will take 11 years just to clear the current appeals--and that doesn't account for all the new appeals that will be coming, Nancy Griswold, chief law judge of the Office of Medicare Hearings and Appeals, told KHN.
The proposed changes seek to simplify the decision-making process and reduce the number of cases referred to the third level of appeals where they must wait for a hearing and then a decision from an administrative law judge, which currently takes an average of more than two years for appeals from providers and suppliers.
HHS' primer on the Medicare Appeals process outlines its strategy to resolve the backlog. The plan's three steps involve increasing adjudication capacity; encouraging resolution of cases earlier in the process; and proposing legislative reforms to provide additional funding and new authorities to address the appeals volume.