Bill to reform Medicare appeals process moves forward

The Senate Finance Committee on Wednesday advanced a bipartisan bill to reform the Medicare appeals process with the hopes of reducing the ever-growing backlog of requests.

Legislation from chairman Orrin HatchOrrin Grant HatchOn The Money — Sponsored by Prudential — Senators hammers Ross on Trump tariffs | EU levies tariffs on US goods | Senate rejects Trump plan to claw back spending Senators hammer Ross over Trump tariffs Top Finance Dem wants panel to investigate Trump Foundation MORE (R-Utah) and ranking member Ron WydenRonald (Ron) Lee WydenOn The Money — Sponsored by Prudential — Supreme Court allows states to collect sales taxes from online retailers | Judge finds consumer bureau structure unconstitutional | Banks clear Fed stress tests States brace for dramatic overhaul to federal foster care funding Supreme Court rules states can require online sellers to collect sales tax MORE (R-Ore.) would create new layers of oversight while also creating new ways for patients to expedite their cases through the system.

The bill, which Wyden described as “a win for all involved,” passed by voice vote.

Under the legislation, the Centers for Medicare and Medicaid Services (CMS) would create an independent Ombudsman for Medicare Reviews and Appeals to help people considering appeals.

CMS would also be able to hire more hands to help slog through the existing backlog, Wyden highlighted during the markup.

For cases involving smaller sums of money, patients can choose to use a new court system designed to speed up those claims. And for multiple pending claims involving the same issues, the patients can choose to have their cases heard together instead of separately.

The backlog of Medicare appeals has been a longstanding problem that is increasingly spurring legal battles.

The Office of Medicare Hearings and Appeals is now receiving more appeals every month that it can handle in a year.

It can take up to two years before it agrees to take on a new appeal. Hospital officials argue that the process slowed dramatically when HHS began hiring private auditors, known as “recovery audit contractors,” to weed through appeals claims to find extra dollars.

The auditors are allowed to keep a cut of any “improper payment” they recover, which can be as old as three years.

The senators’ bill would require much closer coordination between the agency and contractors, Hatch underscored Wednesday.