Medicare’s attempts to reduce the massive backlog of appeals aren’t working, a new report from the Government Accountability Office (GAO) indicates.
 
“This backlog shows no signs of abating” since the number of incoming appeals is still surpassing the adjudication capacity for the third and fourth levels of appeal, according to the report released June 9.
 
The GAO points out inefficiencies in the appeals process that it recommends the Department of Health and Human Services (HHS) improve.
 
Among the things it notes: “HHS efforts do not address inefficiencies regarding the way appeals of certain repetitious claims — such as claims for monthly oxygen equipment rentals — are adjudicated, which is inconsistent with federal internal control standards. Under the current process, if the initial claim is reversed in favor of the appellant, the decision generally cannot be applied to the other related claims. As a result, more appeals must go through the appeals process.”
 
HHS generally agreed with four GAO recommendations but disagreed with a fifth, citing potential unintended consequences, the GAO report states. “GAO agrees and has dropped that recommendation.”
 
With the repetitive claims issue, HHS concurred with the GAO recommendation and noted that the president’s 2017 budget proposes to allow the secretary to consolidate appeals into a single administrative appeal at all levels of the appeals process.
 
“If enacted, this proposal would allow HHS to more efficiently adjudicate appeals of certain repetitive claims,” HHS wrote in its response. “HHS will also assess the use of reopenings to address this issue.”