OIG Report: Training, Policy Clarification Needed in Medicare Appeals Process

November 28, 2012 | Strategic Insights for Health System


The Centers for Medicare and Medicaid Services’ (CMS) Office of Medicare Hearings and Appeals (OMHA) needs to develop and provide coordinated training on Medicare policies to its administrative law judges and qualified independent contractors, according to a November 14, 2012, report from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG). In the report, OIG assesses the impact of regulatory changes in 2005 that required administrative law judges to follow new policies regarding how to apply Medicare policy, when to accept new evidence, and how CMS participates in appeals. OIG found that in fiscal year 2010, administrative law judges reversed qualified independent contractors’ decisions and decided in favor of appellants for 56% of appeals.

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