TMA, AMA Tell Feds to Expedite RAC Audit Appeals

It's a terrible idea to announce a 28-month delay in handling appeals just as physicians' frustration and ire with Medicare recovery audit contractors (RACs) are mounting, TMA, the American Medical Association, and nearly 100 other physician organizations told a federal official.

They called for an immediate solution to the appeals hearings backlog that has caused the delay. "With the numerous new regulatory requirements that physicians are facing today, physicians do not have the resources to navigate an interminable appeals process," they said.

In fact, the groups said in an official letter to Nancy Griswold, chief administrative law judge for Medicare appeals at the Department of Health and Human Services (HHS), physicians want her office and HHS Secretary Kathleen Sebelius to speed up the appeals process for Medicare, Medicare Advantage, and the Medicare prescription drug benefit.

The letter came in response to a notice from Ms. Griswold's office that assignment of requests for administrative law judge hearings may be delayed for up to 28 months and that it might take six months or more after the judge is assigned for the actual hearing to take place.

"The proposal to further delay processing appeals is the most recent example of the barriers to obtaining payment for the delivery of medically necessary and reasonable services to Medicare beneficiaries," the organizations wrote.

"Over the course of years, physicians have increasingly assumed the cost of producing medical records (often repeatedly at various levels of appeal), meeting exacting deadlines, and filing a succession of appeals. The foregoing does not capture the additional opportunity cost associated with the diversion of physician and staff hours from delivering direct medical care to patients. … The numerous appeals requirements, actual costs of filing appeals, and often lengthy delays undermine the ability of physicians to deliver patient-centered care."

The groups pointed out that the auditors are overturned 43.6 percent of the time when physicians and providers appeal RAC determinations. The appeals process is lengthy, time-consuming, and expensive for physicians.

"Because the Medicare contractors often get it wrong," they said, "the Medicare appeals process is of utmost importance."


Action, Feb. 18, 2014


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