HHS Releases Primer for the Medicare Appeals Process

HHS has put together a primer on navigating the complex Medicare Appeals process. According to NHPCO, The Medicare Office of Medicare Hearings and Appeals reports a backlog of more than 880,000 appeals at the end of FY2015. HHS has also issued a new proposed rule to help minimize the backup. 

The primer reviews the five levels of Medicare Appeals, discusses the causes of the Medicare Appeals Backlog and the HHS strategies to improve the Medicare Appeals System. The new HHS strategies include: 

  1. Invest new resources at all levels of appeal to increase adjudication capacity and implement new strategies to alleviate the current backlog.

  2. Take administrative actions to reduce the number of pending appeals and encourage resolution of cases earlier in the process.

  3. Propose legislative reforms that provide additional funding and new authorities to address the appeals volume. 

HHS is predicts that with these actions, the proposed funding and legislative action, the backlog could be as low as just 50,000 appeals by the end of FY 2020. 

Check out the primer here and keep an eye on the blog for more insights and updates.