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GAO: Medicare failing to control appeals; wait time increases 8%+ : 6 things to know

A Government Accountability Office report found the number of appeals from physicians and patients challenging denied claims is escalating and the backlog "shows no signs of abating, " according to Kaiser Health News.

Here are six things to know:

1. The backlog of cases are causing many delayed decisions that exceed timeframes set by certain laws.

2. Due to the backlog, the GAO is imploring the HHS to enhance the process ' oversight and streamline the appeals so the agency takes prior decisions into account. GAO also is asking HHS to handle repetitive claims in a more efficient manner.

3. In the fiscal year 2009, the average wait time for a Medicare appeal decision was 94.9 days. That figure has increased to 819.4 days in fiscal year 2016.

4. In their report, GAO discovered substantial increases in cases filed at each of the four appeal stages. For instance, GAO reported a 62 percent increase at the first level from 2010 through 2014. Appeals at the third stage had an almost 10-fold increase during the time frame.

5. Nancy Griswold, the chief administrative law judge of the Office of Medicare Hearings and Appeals, said "[the request for hearings have increased] so dramatically and so quickly over the past four or five years — during a period of time when our adjudication capacity was not able to keep up for funding reasons — we were drowning. "

6. Sens. Orrin Hatch (R-Utah), Ron Wyden, (D-Ore.) and Richard Burr (R-N.C.) have proposed a bill to combat the problem that aims to enhance HHS oversight and establishing a voluntary dispute resolution process.

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