Coalition Asks HHS to Reform Medicare RAC Appeals Process

The nonprofit American Coalition for Healthcare Claims Integrity has called on HHS to reform the appeals process for payment denials from Medicare recovery audit contractors.

The coalition issued its statement, which was included in letters to House and Senate members, in response to the Office of Medicare Hearings and Appeals' December 2013 announcement of a temporary suspension of most new requests for administrative law judge hearings for at least two years due to a backlog of thousands of cases.

The ALJs are "jamming up the auditing process and undermining the RAC program overall," coalition spokeswoman Becky Reeves said in a news release. The coalition recommends CMS enact long-term reforms to the RAC appeals process to allow the judges to manage incoming appeals more effectively.

Earlier this month, the American Hospital Association responded to the suspension of requests for ALJ hearings with concern. In a letter to CMS Administrator Marilyn Tavenner, AHA Executive Vice President Rick Pollack wrote delays of at least two years in granting a hearing for an appealed claim violate a Medicare statute that requires ALJs to issue a decision within 90 days of receiving the request for a hearing. He asked CMS to work with OMHA to fix the situation to avoid negative effects for hospitals.

More Articles on Medicare RACs:
AHA Urges Congress, CMS to Address Medicare RAC Appeals Suspension
5 Big Mistakes Hospitals Make When Dealing With RAC Audits
3 Key Medicare RAC Issues for Hospitals 

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