The American Orthotic & Prosthetic Association has offered a six-page submission of comments as part of an open comment period to address the increased number of requests for administrative law judge hearings for Medicare providers, suppliers and beneficiaries as well as the backlog of pending cases.
The Department of Health and Human Services (HHS) opened the comment period after the Oct. 29 Medicare Appellate Forum, hosted by the Office of Medicare Hearings and Appeals (OMHA). The comments from AOPA, signed by Thomas Fise, executive director, stated that “without significant changes to the Medicare Recovery Audit Program, the OMHA simply does not have the funding or the administrative resources to significantly reduce the delays. Rather, they continue to grow at an exponential rate.”
AOPA’s comments offered five suggestions. According to AOPA, recovery audit contractor (RAC) activities should be refocused; an extrapolation process should be offered for O&P providers to voluntarily settle claims awaiting an administrative law judge (ALJ) hearing; OMHA should overturn claim denials if they cannot be offered a hearing within 90 days of the request for one; HHS, CMS and OMHA should coordinate their actions; and OMHA funding should be increased to support its increased workload.
The AOPA comments expressed support for OMHA’s efforts to address and reduce the Medicare claims backlog, but stated that “Current efforts … simply are not enough.”
The full comments are available at the AOPA website.