News: Recovery Auditor Backlog Conundrum Continues

After announcing its intention to essentially cut a deal with hospitals in order to settle a backlog of pending denials’ appeals, it now appears that CMS may not have the authority to do so, according to a letter to HHS Secretary Sylvia Burwell from Chairman of the U.S. House Ways and Means Health Subcommittee Rep. Kevin Brady (R-Texas).

 

Brady calls the backlog of appeals at the Administrative Law Judge level “unacceptable” and the lack of due process that comes with the moratorium of assigning new cases “undemocratic,” saying it “undermines the credibility of the Medicare program.”

 

CMS offered to pay facilities 68% of their previously denied claims if they agreed to waive their appeal options, according to an announcement from CMS earlier this month.

 

In his letter, Brady questions CMS’ authority to adopt such a settlement process and questioned the legitimacy of an “all-or-nothing” settlement approach and whether the actual 68% settlement may actually short-change the agency and the Medicare Trust Fund in the long run.