Monday, February 24, 2014
BIRMINGHAM, Ala. (Feb. 17, 2014)—Home medical equipment (HME) providers, hospitals, physicians, hospice and home health agencies have been assaulted by unprecedented numbers of audits. The latest numbers from recovery audit contractor (RAC) publications show that in the first quarter of fiscal year 2013, RACs collected $744.8 million in overpayments. And while all four regions were hit hard, those hit with the most charges included those from Region C, who had to pay back $244 million in the first quarter of 2013. This is only expected to grow. As reported in Decision Health Daily's recent Red Alert, CMS is paying bounties to a new private corporation for spotting and recovering Medicare overpayments. This includes adding a fifth recovery auditor contractor (RAC) that will have jurisdiction nationwide over home health and hospice. This expands on the four existing RACs, which have limited jurisdiction by state. Recently, the Office of Medicare Hearings and Appeals, (OMHA), hosted a very informative and eye opening Medicare Appellant Forum. The purpose was to provide updates to OMHA appellants on the status of OMHA operations and relay information on a number of OMHA initiatives designed to mitigate a growing backlog in the processing of Medicare appeals at the OMHA-level of the administrative appeals process. When a request for a hearing is made, requests are mailed to OHMA and processed manually. The average response time is 18 to 22 weeks, or almost 6 months, to acknowledge that he OMHA request for hearing was received. There are 65 judges hearing cases, Chief Administrative Law Judge Nancy J. Griswold, reported. Judges are hearing, on average, 4.9 (FY13) cases per day. It would take 65 judges 3061 days to rule on one week's worth of cases. • OHMA receives 15,000 cases per week. • OMHA has 375,000 cases assigned to be heard. • There are 480,000 cases waiting to be assigned to a judge. • There are 220,000 cases waiting to be input in to the OMHA system, manually. • 28 months until a case is assigned to a judge. • 177,283 cases have been assigned through July 15, 2014. • Once a case is assigned to a judge the average days to a decision is 329.8 days (after it gets assigned). During the forum, a panel of judges took questions from the attendees. Many of the attendees offered the opinion that the tremendous backlog of cases is due to the massive amount of denials at the lower level of appeals and asked what could be done to provide relief. Chief Administrative Law Judge Nancy J. Griswold expressed several times that OHMA is looking at a "holistic" approach to the challenge that OHMA faces. OHMA is seeking to digitize claims so that claims can be processed electronically, said Bruce Golden, director of information management. Mr. Golden spoke about OHMA's IT efforts to help process claims. According to Golden, a program called “ESCAPE,” should be ready to launch by 2016. By Jonathan Temple, OxyMed, LLC