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 HatchSenate GOP divided over whether they'd fill Supreme Court vacancy  Five takeaways as panel grills tech CEOs Trump awards medal of freedom to former congressman, Olympian Jim Ryun MORE (R-Utah) and ranking member Ron WydenRonald (Ron) Lee WydenTrump signs executive orders after coronavirus relief talks falter Senate Democrats demand answers on migrant child trafficking during pandemic Hillicon Valley: Facebook removes Trump post | TikTok gets competitor | Lawmakers raise grid safety concerns 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.