CMS Whines "O Did I Do That!"

Our friends at CMS issued a strange request on November 5th and published it in the Federal Register.  This request was for information and solicits suggestions for addressing substantial growth in the number of hearings being filed with Office of Medicare Hearings and Appeals, and the backlog of pending cases.  The number of appeals has completely overwhelmed the system.

I wonder who caused this.  Do you think CMS may have created their own problem?  Most of our readers are well aware of the "Bounty Hunters" Recovery Audit Contractors (RACs) and Zone Program Integrity Contractors (ZPICs) who have created havoc in the health care industry with unbelievable claim denials.  I guess if we got paid to deny claims we could probably find millions ($$$$$$$$$) of reasons, but that does not mean the denials are correct. 

Basically CMS broke the system and now they want help fixing the system.  I have a couple of suggestions.  First I would reverse all Home Health Face-To-Face denials due to problems in the physician narrative.  CMS has already eliminated beginning in January of 2015, why not make it retroactive. Next they should require a RAC or ZPIC contractors to pay a penalty of 10 times the amount of claims they have denied that are reversed on appeal.  Of that penalty 5 times the amount should go to CMS and the other 5 times should go to the effective providers, suppliers or physicians.  That will probably make them much more careful with their arbitrary denials.

I along with 99.5% of the healthcare industry want the bad actors forced out of business, but CMS has let these RACs and ZPICs run wild without any control.  Maybe we should all send letters as comments based on the arbitrary denials to the proposal.  Some of the Medicare beneficiaries or their family members should send similar letters for services that were arbitrarily denied.  The clock is ticking, comments should be submitted by December 5, 2014. You can obtain the address for comments by downloading the link below.

I wonder what CMS would do if they had a million comments from providers, suppliers, physicians, and beneficiaries on this notice.  They would probably place another request in the Federal Register requesting help in responding to comments on their previous request.  

LINK