A bipartisan bill cleared by the Senate Finance Committee would augment Medicare administrative law judges (ALJs) with magistrates, a new type of hearing official, and other steps intended to relieve the current backlog of denied claims awaiting ALJ hearings.
 
Although current law requires ALJs to deliver their decisions within 90 days after an appeal has been filed, the backlog of pending cases is nearly 1 million and continuing to grow, the Finance Committee’s report on the legislation states. As a result, the wait for an ALJ hearing currently is estimated to be three years or more.
 
Home health and hospice claims now account for an estimated 30,000 of the pending appeals, according to the National Association for Home Care & Hospice (NAHC).
 
The committee report identifies the expansion of claims audits by CMS contractors in recent years as the primary cause of the backlog and states that the bill would require CMS to improve its oversight of audit practices. In addition, the bill would require CMS to “create new incentives to improve auditor accuracy” and would authorize $127 million a year of Medicare funds to pay for salaries of the new magistrates and other costs of reducing the backlog.