CHA News Article

CMS Proposes Changes to Medicare Claims Appeals Process

The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule that would revise certain requirements for Medicare Parts A, B and D claims appeals. The proposed rule is intended to reduce regulatory burden and improve clarity and consistency in the appeals process. Among the provisions, CMS proposes to eliminate the requirement that appellants sign appeal requests, and change the time frame for vacating dismissals from six months (which can vary from 181 to 184 days) to 180 calendar days.

In addition, following implementation of its January 2017 final rule updating the Medicare claims appeal process, CMS proposes a number of provisions to address regulations it believes require additional clarification, including correcting technical errors and omissions, and removing regulatory requirements identified as redundant. Finally, CMS proposes a number of technical corrections, including references to new Medicare beneficiary identification numbers and regulatory cross-references to previously finalized regulations. Comments on the proposed rule are due Dec. 3.

In addition, the Office of Medicare Hearings and Appeals (OMHA) recently published a revised chapter of the OMHA Case Processing Manual. Specifically, OMHA updated Chapter 14, which addresses scheduling and noticing for prehearing conferences and hearings. The revisions are part of an ongoing effort to make the manual more user friendly and reflect regulatory changes finalized in 2017. CHA member hospitals are encouraged to review the process changes outlined in the manual, as well as the short proposed rule, and share feedback with CHA as it considers next steps in continued advocacy.