Medicare’s Efforts To Curb Backlog Of Appeals Not Sufficient, GAO Reports

This is appalling. It's worse than SSA, which is the gold standard for unacceptable delay in appeals....
http://goo.gl/QJvXC4

Despite interventions by Medicare officials, the number of appeals from health care providers and patients challenging denied claims continues to spiral, increasing the backlog of cases and delaying many decisions well beyond the timeframes set by law, according to a government study released Thursday.

The report from the Government Accountability Office, said the backlog “shows no signs of abating.” It called for the Department of Health and Human Services to improve its oversight of the process and to streamline appeals so that prior decisions are taken into account and repetitive claims are handled more efficiently.

Growing Wait Time

The average wait for a Medicare appeal decision by an administrative law judge has spiraled over the past eight years

Average Processing Time By Fiscal Year

Fiscal Year Number of Days
FY09 94.9
FY10 109.6
FY11 121.3
FY12 134.5
FY13 220.7
FY14 414.8 
FY15 661.1
FY16 Average 819.4

1st Qtr 795.8
2nd Qtr 860.6

Content last reviewed on May 4, 2016