Home Health & Hospice Week

Appeals changes in the works.

Not all of the provisions in the Obama administration’s 2017 budget proposal that you should care about are home care and hospice-specific. Take a look at these more general provisions that can affect you:

• Appeals. The proposal contains multiple ideas for relieving some of the backlog at the Office of Medicare Hearings and Appeals and Departmental Appeals Board.

Idea #1: The Department of Health & Human Services would impose appeals user fees. “A per-claim filing fee at each level of appeal” would allow HHS “to invest in the appeals system to improve responsiveness and efficiency,” the proposal says. “Fees will be returned to appellants who receive a fully favorable appeal determination.”

Idea #2: Under the proposal, HHS would “retain a portion of Recovery Audit Contractor recoveries … [to] allow Recovery Audit program recoveries to fully fund Recovery Audit Contractorrelated appeals” at OMHA and DAB.

More ideas: The proposal also calls for using Medicare magistrates for appealed claims below the federal district court amount in controversy threshold ($1,500 in 2016) to reserve Administrative Law Judges for “more complex and higher [AIC] appeals; allowing ALJs to rule without a hearing when no material facts are in dispute; remanding appeals to the redetermination level if new evidence is introduced; using sampling and extrapolation; and consolidating appeals.

• User fees. The administration proposes user fees for survey revisits, registering clearinghouses and billing agents, and Medicare enrollment.
• IPAB. The proposal would lower the “target rate” that would trigger the Independent Payment Advisory Board, which would recommend cost reduction policies to Congress.