Senate Finance Committee Approves Legislation Reforming Medicare Audit and Appeal System
June 9, 2015 10:49 AM
The Senate Finance Committee last week passed out of committee the Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015, which would reform the Medicare audit and appeal process. As previously reported, the Committee held a hearing in April to discuss proposals to make the audit and appeal system more efficient.
Following that hearing, the National Association for Home Care & Hospice (NAHC) submitted recommendations for the Committee to consider in developing legislation to reduce faulty claims denials and the resulting plethora of appeals. The Senate Finance Committee continued to consult NAHC in developing the AFIRM Act and included NAHC’s recommendations in the bill that passed out of committee. For example, the bill included NAHC’s recommendations to increase resources, improve the accuracy and quality of determinations, and establish a settlement process for appellants.
Chairman Orrin Hatch (R-UT) called the bill “an important step toward streamlining the Medicare audit and appeals process to help healthcare providers better serve millions of patients across the nation. This is a common sense bill that will help untangle the web of red tape that ensnares the current audit and appeals process and guarantee Medicare patients continue to have access to high-quality care. I look forward to continuing to work with my colleagues on both sides of the aisle to move this bill forward.”
Ranking Member Ron Wyden (D-OR) said it was “a strong, bipartisan bill that will begin to ease the tremendous backlog of Medicare appeals that have been frustrating seniors and providers in Oregon and across the country. Making the Medicare audits and appeals process more efficient will help resolve the cases quickly and at the earliest possible step. I will be working hard to see swift action to help fix this broken system.”
The bill would provide more resources by requiring appropriations of $125 million per year to the Office of Medicare Hearings and Appeals and $2 million per year to the Departmental Appeals Board of HHS in order to conduct reviews, hearings, and appeals. The bill also establishes beginning in 2017 a new track for less costly and less complex cases, as well as a settlement process for appellants, as recommended by NAHC.
For more information about and a summary of the AFIRM Act, please click here.