Tags: Healthcare Reform | medicare | appeals | backlog | beneficiaries

Medicare Extends Priority Appeals Process for Seniors

By    |   Monday, 22 December 2014 07:41 AM

With some 900,000 individuals, physicians, and health providers appealing decisions about Medicare coverage eligibility, the Office of Medicare Hearings and Appeals says it will extend the policy that gives priority to cases brought by individual beneficiaries, The Washington Post reported, citing Kaiser Health News.

The beneficiary-first policy was initially announced in January by Chief Judge Nancy Griswold as an interim measure. It has already cut the waiting time that seniors encounter before seeing an administrative judge in half.

The beneficiary appeals backlog for individuals is expected to be reduced still further in 2015, the Post reported.

Hearings from hospitals, doctors and other care providers are suspended for at least two years, the Post said.

Most of the 5,162 cases filed by beneficiaries in FY 2013, plus another 1,535 cases held over from previous years, were decided, the hearings office reported, according to Kaiser Health News.

The wait time for health providers, though, has doubled.

Hospitals often appeal auditors' decisions to reduce Medicare payment for patient admissions. Medicare can deny reimbursement on the grounds that patients should have been kept only for observation, which saves money because they are then not eligible for admittance to nursing homes.

Hospitals say that they usually win their appeals, the Post reported.

Under Griswold's policy,  now extended, beneficiaries have had to wait an average of 113 days for a hearing — better than the previous 235-day wait, though still short of the federally mandated 90 days it's supposed to take from application to hearing.

A typical case might involve an applicant who has been denied eligibility for nursing- home coverage, the Post reported.

"We are striving toward that 90-day mark," said Jason Green, a Medicare policy director.

Seniors citizens are instructed to mark their appeals "Attn: Beneficiary Mail Stop" so that the hearings office can flag their cases for priority handling.

Individual beneficiaries
who first made their appeals prior to the new expedited policy was announced are advised to write to the "Attn: Beneficiary Mail Stop" or call 855-556-8475  to make certain they, too, get priority treatment.

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The federal office responsible for appeals for Medicare coverage says that it will extend the policy that gives priority to cases brought by individual beneficiaries over appeals from hospitals and doctors, reports say.
medicare, appeals, backlog, beneficiaries
Monday, 22 December 2014 07:41 AM
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