Taking action to improve the Medicare appeals process

Taking action to improve the Medicare appeals process

June 28, 2016

By: Nancy Griswold, Chief Administrative Law Judge, Office of Medicare Hearings and Appeals and Constance B. Tobias, Chair, Departmental Appeals Board

Every year, Medicare processes an estimated 1.2 billion fee-for-service claims for more than 33.9 million Medicare beneficiaries who receive health care benefits through the Original Medicare program.  Accurate and efficient payment and processing of claims for the services these beneficiaries receive is important to ensuring the integrity of the Medicare program. However, when Medicare beneficiaries or providers disagree with a coverage or payment decision made by Medicare, a Medicare health plan, or a Medicare Prescription Drug Plan, they have the right to appeal that decision.

Today, the U.S. Department of Health and Human Services (HHS) issued a Notice of Proposed Rulemaking (NPRM) on changes to the Medicare claims appeal process. The NPRM is part of the Administration’s efforts to address the unprecedented and sustained increase in the number of appeals and to eliminate the backlog of appeals currently pending at the Office of Medicare Hearings and Appeals (OMHA) and the Departmental Appeals Board (DAB).
READ MORE: Taking action to improve the Medicare appeals process