August 5, 2015

When the RACSs Attack? Write your Congressman and Fight Back!

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Two bills were recently introduced in Congress to address the growing backlog of hearings at the Office of Medicare Hearings and Appeals (OMHA). The first is H.R. 2156, the Audit Improvement Act, introduced by U.S. Rep. Sam Graves, R-Mo., which was referred on May 1 to the Subcommittee on Health. That’s the latest information on H.R. 2156, so sending a note to your representative to get it moving along would be helpful – one provision of the legislation would limit the scope of Recovery Auditor (RAC) review to information the doctor had available at the time of the decision to admit. 

The other bill is the Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015. AFIRM provides for 119 new administrative law judge (ALJ) teams, but it’s not a panacea for all that ails the Medicare hearing process. Needing some work is its proposal to remand files back to the Medicare Administrative Contractor (MAC) if new evidence is submitted to the ALJ or the Medicare Appeals Council while allowing the Centers for Medicare & Medicaid Services (CMS) and its contractors an exception to the mandatory remand. Why not make CMS offer its evidence with its denial letters? Of further concern is U.S. Sen. John Thune’s amendment making Medicare magistrates contractors instead of federal employees. 

Congress goes on recess next week until after Labor Day, and as I wrote in my recently released book Hurry Up and Wait, now is the time to talk with your senators and representatives. 

How do you write your representative? Search the Internet to find him or her.

Then the question becomes: call, email, or write? There’s nothing like a handwritten letter. Here’s an outline that gets right to the point: 

 

The Honorable (Name): 

Dear Congressman / Senator:

May I invite your attention to the 500,000-plus case backlog at the Office of Medicare Hearings and Appeals (OMHA) and the solutions proposed by H.R. 2156 and the AFIRM Act, which passed out of the Senate Finance Committee on July 3? 

Please support H.R. 2156, because it eliminates contingent payment to Recovery Auditors, and because it also ends Monday-morning quarterbacking of doctor’s decisions.

Please also consider that while AFIRM provides for hiring more ALJ teams, its provisions for automatic remands when new evidence is offered would add to the backlog, and AFIRM should not allow an exception to this for Medicare contractors. Finally, please consider that making the proposed Medicare magistrates temporary contractors instead of full-time equivalents, thus removing any incentive for the most qualified candidates to seek those appointments.

Thank you for your time, and for helping decrease the ever-increasing backlog at the Office of Medicare Hearings and Appeals. 

                                                      Sincerely,

 

Feel free to add a bit more information, but to make sure you keep their attention, limit it to a page. A more detailed analysis of the bills and the issues facing the hearing process are beyond the scope of this article. Chapters 12 and 13 of Hurry Up and Wait analyze H.R. 2156 and the AFIRM Act in detail and offer alternatives, leading on to Section 4 suggesting how you can make your voice heard. 

If we all do our part, we can make sure that government continues to be by the people, for the people, and of the people. 

About the Author 

Bob Soltis is considered a leading authority on the art of persuasion, Medicare hearings, and hearing ethics. A former Navy Judge Advocate and retired ALJ who has taught lawyers to effectively present their cases, he is the founder of the Advocacy Akademie. His book Hurry Up and Wait: Our Broken Medicare Appeal System, was released on July 30.

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Bob Soltis

Bob Soltis is a success coach and the author of How to Handle Your Medicare Hearing. A former U.S. Navy officer, he decided 4,500 cases during eight years as an ALJ at OMHA. 

 

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