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Medicare Appeals System ‘Buckling Under Its Own Weight’

Agency feels budget pinch

The Senate Finance Committee is demanding that more attention be paid to the growing backlog of Medicare appeals claims, which federal officials are continuing to blame on a lack of funding, according to The Hill. The Office of Medicare Hearings and Appeals is receiving a record number of appeals, with the processing time for each claim more than quadrupling over the last 5 years to an average of 550 days.

“We definitely feel the urgency,” Nancy Griswold, the chief law judge at the Office of Medicare Hearings and Appeals, told the committee on April 28. “We are keenly aware of the impact that these delays are having.”

Griswold urged support for President Obama’s proposed budget, which would grow the cash-strapped agency’s budget by nearly $300 million. The additional funds would help double the office’s capacity to process cases, she said.

The agency’s budget was $82.3 million over the last fiscal year, up from $69 million the previous year. Its staffing has increased from 492 to 514 over the same period.

The Medicare administrative judge also supported an idea from the panel’s top Democrat, Sen. Ron Wyden (D-Ore.), who proposed a refundable filing fee to keep out providers who are “gaming the system.”

“I think a filing fee would encourage appellants to take a closer look at what they are appealing,” Griswold said.

The Office of Medicare Hearings and Appeals received a staggering 700,000 claims in fiscal year 2013 –– compared with 60,000 submitted 2 years prior.

Despite the 10-fold jump in claims, the number of officers handling cases remains at 60, Wyden pointed out.

“It’s no wonder that the appeals system is buckling under its own weight,” Wyden told the committee.

Committee chairman Orrin Hatch (R-Utah) did not endorse any specific proposals to reform the appeals system, but sounded the alarm about the growing problem.

“We understand that handling a large volume of appeals is a daunting task ,” Hatch said. “We must work in tandem if the process is to be reformed.”

Source: The Hill; April 28, 2015.

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