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Tuesday, January 21, 2014

As HHS Moves To End Overload Of Medicare Claims Appeals, Beneficiaries Will Get Top Priority

Medicare beneficiaries who have been waiting months and even years for a hearing on their appeals for coverage may soon get a break as their cases take top priority in an effort to remedy a massive backlog.

Nancy Griswold, the chief judge of the Office of Medicare Hearings and Appeals (OMHA), announced in a memo sent last month to more than 900 appellants and health care associations that her office has a backlog of nearly 357,000 claims. In response, she said, the agency has suspended acting on new requests for hearings filed by hospitals, doctors, nursing homes and other health care providers, which make up nearly 90 percent of the cases. She said that she expected the suspension would last about two years.

But beneficiaries’ appeals will continue to be processed, and officials are seeking to “ensure that the relatively small numbers of beneficiary-initiated appeals are being immediately addressed by prioritizing their cases,” the Department of Health and Human Services said in an announcement in the Federal Register.

“Because they are among our nation’s most vulnerable populations, OMHA is committed to being as responsive as possible to the Medicare beneficiary community, regardless of the challenges presented by the significant increase in the number of requests being filed,” Judge Griswold wrote in an email in response to a reporter’s questions. “Beneficiary appeals continue to be assigned as quickly as OMHA can process...

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