Lawmakers defend providers over backlogged Medicare appeals
Frustrated lawmakers are criticizing the Medicare appeals process that has wilted with the increase in audits recently. Federal officials from two key agencies agreed that the Medicare’s Recovery Audit Contractor (RAC) program needs to be revised.
A backlog of 460,000 appeals are pending for administrative law judge hearings. One Representative stated it could take “10 years to clear” provided all administrative law judges called for by CMS were hired, a move that is not likely to occur. This means provider payments may be help up while appeals are under way, a source of frustration and anger for lawmakers and providers.
From 2007 to 2013, RAC appeals soared from 20,000 to 192,000, but funding for the Office of Medicare Hearings and Appeals (OMHA) did not increase. Officials agree that more needs to be done to ensure program integrity as RAC audits have grown from 1,500 to 15,000 per week.