Medicare Appeals Process:

Part B Changes Appear to Be Fulfilling Their Purpose

HRD-90-57: Published: Jul 16, 1990. Publicly Released: Jul 16, 1990.

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Pursuant to a congressional request, GAO provided information on changes in claim volume and outcomes at the carrier level following changes in the Medicare Part B appeals process.

GAO found that: (1) in 1988, the Health Care Financing Administration (HCFA) required disputed Part B cases over $500 to go through a carrier hearing before appeal to an administrative law judge; (2) from January 1987 through March 1989, most cases reviewed in hearings involved physicians; (3) the proportion of cases heard by telephone or in person decreased from 29 to 6 percent; (4) the percentage of carrier hearing decisions resulting in payments to claimants decreased after the introduction of mandatory hearings; and (5) the proportion of cases appealed to administrative law judges increased from 11 to 13 percent.

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