Send Lawyers, Guns and Money…

"Our serious concerns remain," Parkinson says of the HHS audit appeal backlog.

“Our serious concerns remain,” Parkinson says of the HHS audit appeal backlog.

Good afternoon, ProviderNation.

HHS had its party and everyone was invited. But it was hardly the social event of the season.

The fab forum on the agency’s awful backlog of audit appeals went down yesterday. Advocates say they haven’t heard what they needed to hear.

“Unless policy and process improvements are introduced soon,” AHCA honcho Mark Parkinson says, “the appeals process will become even more dysfunctional.”

According to a couple of participating informants, HHS types repeated complaints about their workload (350,000 cases and counting) but, looking on the bright side, they said they’ve increased productivity (raising their decisions per day from 2.2 in 2009 to 4.9 per day last year).

If that didn’t win the audience over, HHS types made it even worse by claiming the freeze in new appeals wasn’t “a moratorium,” but a “deferred assignment” process.  Our participating informants heard that as, “Send Lawyers, Guns and Money.”

HHS officials are promising that they’ll open a new regional office somewhere in America’s middle and draw up a new manual with “best practices.” They’ll also use voluntary statistical sampling, and offer mediation.

Finally, HHS says there will be a new rulemaking notice offering the public a chance to offer comments and suggestions. So you got that going for you, which is nice.

Parkinson says his group “applauds” HHS officials “for this effort and will make every attempt to work with HHS on this process.”

But he adds that there must needs “be fewer inaccurate Medicare contractor audits” or more money and time spent on the casework.

“Something must change to permit timely and appropriate initial claim processing and early appeal decisions,” Parkinson says. “If not, the backlog could cause disruptions to beneficiary access to health care, especially to nursing and therapy services.”

Bill Myers is Provider’s Senior Editor.

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