Health Care Providers Must Wait for RAC Appeal Hearings While Medicare Beneficiaries Receive Top Priority

Tuesday, January 28, 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In December 2013, the U.S. Department of Health and Human Services’ (HHS) Office of Medicare Hearings and Appeals (OMHA) notified hospitals, doctors, nursing homes and other health care providers that due to a backlog of Recovery Audit Contractor (RAC) appeals, the agency would be suspending acting on new requests for hearings filed. Health care providers were told they would not be able to submit any new appeals until the existing backlog clears, which could take two or more years.

However, according to Kaiser Health News, Medicare beneficiaries waiting for hearings on appeals are being moved to the front of the line.

To read my previous blog on the backlog of RAC appeals, click here.


Backlog of Appeals Worse Than Ever.


According to the OMHA, the nation’s 65 Medicare administrative law judges have a collective backlog of 357,000 appeals to work through before they can start to accept new appeals. The OMHA estimates the average wait time for providers for a hearing before an administrative law judge has risen to 16 months and is expected to continue to climb.


OMHA Will Clear Beneficiaries’ Appeals First.

The OMHA stated on January 21, 2014, that contrary to health care providers’ appeals, Medicare beneficiaries’ appeals will continue to be processed and officials are ensuring that beneficiary-initiated appeals are being immediately addressed. According to Kaiser Health News, beneficiary appeals continue to be assigned as quickly as OMHA can process them. As a result, the appeal process for beneficiaries is expected to decrease.

To read the entire Kaiser Health News article, click here.


Mistakes Providers Make When Dealing with RAC Audits.

As much as possible, providers need to avoid mistakes when dealing with RAC audits. I previously wrote a blog highlighting some of the actions we recommend you take in responding to a Medicare audit. The most important step you should take is to consult an experienced health law attorney early in the audit process to assist in preparing the response.  Click here to read more on how to respond to a Medicare audit.


RAC Audits Are Here to Stay.

In the first three months of the fiscal year 2013, RACs recouped more than $2.2 billion from providers due to what the RACs deemed were overpayments. With money coming in, RAC audits are not going away. It has become common for state and federal regulators to enforce even the smallest violations, resulting in investigations, monetary fines and penalties. If found in violation, you will not only have to pay fines and face disciplinary action, you will also lose revenue because you will have to spend time dealing with the investigation, instead of practicing medicine. Whether you are trying to prevent Medicare and Medicaid audits, Zone Program Integrity Contractor (ZPIC) audits, or any other kind of healthcare audits, there are steps you can implement in your practice today that may save you down the line. Click here to read more on self audits.


Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.


Comments?

Does it bother you that Medicare beneficiaries’ appeal hearings will be heard before providers’? What do you think about the backlog of RAC appeals? Please leave any thoughtful comments below.


Sources:


Jaffe, Susan. “As HHS Moves to End Overload Of Medicare Claims Appeals, Beneficiaries Will Get Top Priority.” Kaiser Health News. (January 21, 2014). From: http://bit.ly/1mQAWqz

EHR Intelligence. “AHA Urges CMS to Remedy Process for Appealing RAC Audits.” EHR Intelligence. (January 16, 2014). From: http://ehrintelligence.com/2014/01/16/aha-urges-cms-to-remedy-process-for-appealing-rac-audits/



About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


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1/28/2014

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