Healthcare Providers’ Medicare Appeals Further Delayed
- By BSTQ Staff
Medicare appeals hearings from hospitals, doctors and other providers have been suspended by the Office of Medicare Hearings and Appeals (OMHA) because it has moved beneficiaries to the front of the line. As of this writing, approximately 900,000 appeals are awaiting decisions, with most filed by hospitals, nursing homes, medical device suppliers and other healthcare providers, according to Jason Green, OMHA’s program and policy director. Hospitals file more appeals than all other providers due to an increasing number of Medicare payment denials for patients who have been admitted to the hospital but who auditors later say should have been kept instead for observation, a status that reduces payments. The wait times for health providers’ cases have doubled since last year and are nearly four times longer than the processing time for beneficiary appeals.
In January, Chief Judge Nancy Griswold issued a “beneficiary-first” policy, a temporary measure that will remain in place as long as there is a backlog. Since then, beneficiaries have waited 113 days on average for a hearing compared with 235 days the year before. Reaching OMHA is the third of four stages in the appeals process and the first opportunity for Medicare beneficiaries or healthcare providers to present their case before a judge. The third stage offers higher odds for winning an appeal; previous levels involve only a review of the case files.
