GAO recommends HHS take steps to reduce Medicare appeals

The Department of Health and Human Services should take certain steps to reduce the number of Medicare appeals and strengthen oversight of the Medicare fee-for-service appeals process, the Government Accountability Office said in a report issued today. “Without more reliable and consistent information, HHS will continue to lack the ability to identify issues and policies contributing to the appeals backlog, as well as measure the funds tied up in the appeals process,” the report concludes. “Finally, the manner in which appeals of certain repetitive claims are adjudicated is inefficient, which leads to more appeals in the system than necessary.” Requested by leaders of the Senate Finance Committee, the report examines trends in appeals for fiscal years 2010 through 2014; data HHS uses to monitor the appeals process; and HHS efforts to reduce the number of appeals filed and backlogged. The third appeal level, in which Administrative Law Judges hear the appeal, experienced a 936% increase in filed appeals over the period, largely driven by appeals of hospital and other inpatient stays, GAO found. Appeal decisions exceeding statutory time frames at the first four levels of appeal generally increased over the period, with most frequent delays occurring at the third and fourth levels. In the report, HHS said it agreed with most of the recommendations.