Performance Improvement 2009. Do Contractors Meet Requirements for Processing Medicare Claims Reconsiderations?

01/01/2009

This study examined whether qualified independent contractors met Medicare Parts A and B claims reconsiderations requirements.

From May 2005 to July 2006, qualified independent contractors handling Medicare Part A claims reconsiderations met 60-day processing requirements and 58 percent of Medicare Part B reconsiderations did not meet processing timeframes. Four contractors did not follow all requirements relating to correspondence, such as letters acknowledging appeal requests, notifications of the reconsideration decision, and notifications of processing delays. For 54 percent of reconsiderations, contractors did not enter accurate information in the Medicare Appeals System, which stores reconsideration data and is used by the agency to monitor contractor adherence to processing requirements. Contractors had not been operational for long at the time of our review and the agency awarded a contract to a private entity to conduct its own performance evaluation and made several changes to the second level of Medicare appeals to improve the reconsiderations process.

Report Title: Early Implementation Review of Qualified Independent Contractor Processing of Medicare Appeals Reconsiderations http://oig.hhs.gov/oei/reports/oei-06-06-00500.pdf
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact: Erin Lemire, 202-205-9523
Performer: Staff; Office of Inspector General
PIC ID: 9000

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