On February 16, 2016, the Congressional Budget Office (CBO) issued a cost estimate report on the Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015 (S. 2368). The purpose of the Act is to address the severe backlog of Medicare appeals and to improve the appeals process. The CBO estimates that the Act will increase direct spending under the Medicare program by approximately $1.7 billion over 2016 to 2026.
The Act would address the Medicare appeals process in several ways, such as by:
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Mandating the creation of Medicare magistrates to handle simple claims appeals that are now handled by Administrative Law Judges;
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Instituting an expedited appeals process;
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Establishing alternative dispute resolution processes;
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Modifying the operations of Recovery Audit Contractors (RACs); and
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Allowing the consolidation of multiple appeals cases related to similar issues or individuals.
In addition to the increase in direct spending, CBO estimates the amount of discretionary spending (i.e., spending subject to annual appropriations) to implement the Act is estimated to be approximately $35 million over that same period. Part of that cost would be the creation of an Internet portal through which providers could monitor the status of claims in the appeals process, and the establishment of an ombudsman position to assist providers, suppliers, and Medicare contractors in resolving complaints and inquiries.
The CBO report is available here.
Reporter, Jennifer S. Lewin, Atlanta, + 1 404 572 3569, jlewin@kslaw.com.
