Earlier this week, the HHS Office of Medicare Hearings and Appeals held a forum to discuss a backlog in appealed claims concerning payment denials from Medicare recovery audit contractors, according to an AHA News report.
OMHA staff offered tips for providers on formatting appeals to make the process more efficient, according to the report. They also discussed initiatives to improve the process, such as an electronic appeals system.
In December, OMHA announced a temporary suspension of most new requests for administrative law judge hearings concerning payment denials from RACs due to a backlog in appealed claims.Most new hearing requests will be delayed by at least two years. Last month, the American Hospital Association urged CMS to work with OMHA to address the suspension to mitigate detrimental effects for hospitals.
Earlier this week, 111 House members sent a letter to HHS Secretary Kathleen Sebelius asking her to take immediate action to reform the RAC program. The temporary suspension of administrative law judge hearing requests illustrates a need for change, the lawmakers wrote.
At the OMHA hearing, AHA Senior Associate Director of Policy Melissa Jackson also urged the agency to address the accuracy of RAC payment denials, according to the report. Hospitals are successful at overturning Medicare Part A denials 72 percent of the time, indicating a high level of inappropriate denials, Ms. Jackson said.
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