The shifting landscape of the Medicare administrative appeals process: New opportunities for healthcare providers and suppliers

Abstract

The Office of Medicare Hearings and Appeals has recently announced various initiatives to reduce the number of appeals pending for resolution through the Medicare administrative appeals process. Although federal statute requires that hearings on disputed Medicare appeals be heard and decided within 90 days, current estimates reflect that providers are waiting over three years for a hearing date on their pending appeals. The new resolution initiatives come on the heels of federal litigation against the United States Secretary of Health and Human Services (Secretary) by the American Hospital Association and healthcare providers, demanding the Secretary’s compliance with federally prescribed appeal adjudication time frames. The new initiatives include a lump sum settlement offer, mediation process and consolidated hearing programme which utilises statistical sampling and extrapolation. These initiatives are designed to provide an efficient and expedited alternative to the standard appeals process. Some of these initiatives are currently ongoing and interested Medicare providers and suppliers should understand each programme’s eligibility criteria and promptly evaluate participation.