OIG: Redeterminations on the rise

Friday, October 4, 2013

WASHINGTON – Contractors processed 2.9 million redeterminations involving 3.7 million claims in 2012, a 33% increase since 2008, according to report from the Office of Inspector General (OIG). Also among the findings in the report, titled “The First Level of the Medicare Appeals Process, 2008–2012:  Volume, Outcomes, and Timeliness”: Contractors decided in favor of Part A appellants at a lower rate than Part B appellants; and 80% of redeterminations involved Part B services, although those involving Part A services have risen more rapidly. The report also found that contractors largely met the required timeframes for processing redeterminations and paying appeals, but they fell short on meeting timeframes for transferring case files for second-level appeals. The OIG recommends that CMS use the MACs to monitor contractor performance; continue to share information among contractors; and monitor the quality of redetermination data in the Medicare Appeals System (MAS).