Government Oversight Committee Focuses on Medicare Appeal Backlogs

At a House Committee on Oversight and Government Reform Health Subcommittee hearing, the Chairman, James Lankford(R-OK) , said the third level of Medicare appeals has a massive backlog of 460,000 claim appeals that could take up to 28 months to resolve individually. There appeared to be a bipartisan agreement that the role Recovery Audit Contractors (RAC) has contributed to the delay. Witnesses from the Government Accountability Office (GAO) and the HHS OIG testified that the RAC program needs reform, such as ensuring that all RACs operate using the same Medicare coverage and payment guidelines. The CMS witness said that the agency is in the process of revising the RAC program to reflect the concerns of the affected parties.

Senators Again Ask CMS to Delay DME Competitive Bidding

Senators John Thune (R-SD) and about thirty other senators sent a letter to CMS saying that “Before you move forward in implementing competitive bidding nationally, we request that you allow the OIG to complete their investigation on competitive bidding licensure problems and verification of Round 2 single payment amounts and give Congress time to review the results….”

Delay in EHR Mandate Proposed

CMS issued a proposed rule under which providers and hospitals that are unable to obtain an electronic health record (EHR) system with the latest meaningful use program certification can participate in the program in 2014 using certain existing EHR systems.

CMS Issues Final MA/Part D Provider-Abuse Rule

CMS issued a final rule under which most providers who prescribe drugs under Medicare Part D will be required to be enrolled in Medicare. The rule also allows CMS to revoke a physician or eligible professional’s enrollment if the agency determines that there has been a pattern or practice of prescribing that is abusive, represents a threat to the health and safety of Medicare beneficiaries or otherwise fails to meet other Medicare requirements.

Rule on Prior Authorization of Medicare Equipment

CMS published a proposed rule under which prior authorization would be required earlier in the purchasing process of certain medical equipment. CMS said that the fraud and error prevention measure would likely save Medicare $740 million over ten years. CMS also proposed to expand Medicare demonstration projects which would require prior authorization for power mobility devices, the use of hyperbaric oxygen therapy and repetitive scheduled nonemergency ambulance transport.

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