Centers for Medicare and Medicaid Services (Photo: CMS) Centers for Medicare and Medicaid Services (Photo: CMS)

Medicare program managers are trying to clean up Medicare claims and drug coverage determination appeals rules.

Officials at the Centers for Medicare and Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services, published a batch of new final appeal program regulations this week in the Federal Register.

The new rules may affect clients who want the original Medicare Part A hospitalization benefits program to cover an operation it has not normally covered, or a Medicare Part D plan to cover a drug the plan does not think it ought to cover.

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Many of the updates deal with highly technical issues, such as exactly what happens when a patient without a legal representative wants a video teleconference hearing, or an in-person hearing.

One of the somewhat less technical updates deals with the rules for signatures.

Medicare officials have decided to stop asking for signatures on appeal requests for Medicare A hospitalization or Medicare Part B outpatient and physician services appeals, or for Medicare Part D drug plan coverage determination appeals.

Already, “there is no requirement that appeals sign appeals requests for appeals of Part C [Medicare Advantage] organization determinations,” officials write in the preamble to the final regulations.

In theory, patients could use signatures could use the signatures to attest to the honesty and accuracy of their requests for appeals, but “given that our existing statutory authority limits our ability to enforce certain attestations, we found the signature requirement unnecessary,” officials write.

Officials estimate that Medicare enrollees file 4.5 million appeal requests per year, and that missing signatures now lead the appeals reviewers to dismiss about 284,000 appeal requests per year.

Resources

A copy of the new final regulation is available here.

— Read Feds Say Group Plans Get One Appeal per 2,900 Claims, on ThinkAdvisor.

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