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Clogged Medicare Appeals Process May Persist Unless Government Acts  
Clogged Medicare Appeals Process May Persist Unless Government Acts
Over 2+ year appeals process & deferred assignment will begin to
impact health care delivery to seniors and others, says Parkinson
AHCAPressOffice@ahca.org                                                                                                     (202) 898-3165
FOR IMMEDIATE RELEASE

2/12/2014

Washington, D.C. – The American Health Care Association (AHCA) released a statement today following Wednesday’s all-day forum sponsored by the Office of Medicare Hearings and Appeals (OMHA).  The gathering was hosted by OMHA to discuss agency initiatives to help mitigate the growing backlog, hear provider concerns, and to examine the causes and various ways providers can cope with the enormously lengthy, over two year delay for a provider’s appeal to be adjudicated at the Administrative Law Judge level, or Level 3 of the 5-step Medicare claims appeals process.

The following is a statement from President and CEO Mark Parkinson:

“Our serious concerns remain. Unless policy and process improvements are introduced soon, the appeals process will become even more dysfunctional.

“There needs to be fewer inaccurate Medicare contractor audits -- which are increasing appeals significantly -- or additional resources provided to OMHA. If not, the backlog could cause disruptions to beneficiary access to health care, especially to nursing and therapy services.

“AHCA applauds OMHA for this effort and will make every attempt to work with HHS on this process, and to find solutions that work for the provider, agencies, and most importantly, the recipients of the care we deliver.  Something must change to permit timely and appropriate initial claim processing and early appeal decisions.” 

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The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 12,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and developmental disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit www.ahca.org or www.ncal.org.


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