CMS on Backlog: ‘How Did Things Ever Get So Far?’

 

CMS says it will hire non-binding mediators to try to tackle its monstrous Medicare audit appeals backlog.

CMS says it will hire non-binding mediators to try to tackle its monstrous Medicare audit appeals backlog.

Good morning, ProviderNation. “How did things ever get so far?” the fine folks at CMS are wondering. The agency is launching an experiment it’s calling the Settlement Conference Facilitation Pilot, hoping against hope that it will help CMS deal with its monstrous audit appeals backlog.

You’ll recall that, in February, the Obama administration called a great big timeout because it was overwhelmed with administrative Medicare appeals from auditors. The People weren’t exactly thrilled with things.

Now, the administration will hire Medicare appeals officers they’re calling “facilitators.” Their mission, (should they choose to accept it) will be to mediate disputes between auditors and providers and, in CMS’ quaint words, “to discuss the potential of a mutually agreeable resolution for claims.” The facilitator won’t be able to rule on the merits of any claim. If he or she can get folks to set aside their feudin’ and a-fussin’, why, then, there will be the peace.

If not, of course, people are free to make their own offers to administrative law judges.

While we’re talking about the fine folks at CMS (and we’re epically mixing metaphors), the agency also says it’s giving a rethink to policies and payments for end-stage renal disease. Under the proposal, contractors and providers wouldn’t get a Medicare market basket update, but they’d get a slight wage-index bump. So you got that going for you, which is nice.

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

 

 

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Filed under health care, Long term care, Post-acute care

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