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While Monday’s partial shutdown of the federal government will furlough nearly 52 percent of the U.S. Department of Health and Human Services (HHS) workforce, recovery auditors will continue to review claims even though the Medicare claims appeal process is expected to be disrupted.

“The shutdown does not affect reimbursement,” Emily Evans, partner at Obsidian Research, said in an email to RACmonitor. “Recovery auditors (RACs) will continue their work since they are supported by programmatic revenue.”

Still, during the shutdown, the length of which has yet to be determined, Medicare Administrative Contractors (MACs) will continue to perform all of their functions related to Medicare fee-for-service claims, processing, and payment and electronic health record (EHR) incentive payments will be processed as usual.

One major problem that the partial shutdown is creating is the aforementioned issue of the Medicare claim appeals process being unable to continue, leaving providers (along with state Medicaid agencies and beneficiaries) without the ability to appeal CMS payment decisions on claims. 

In a memo posted on the HHS website, the Office of Medicare Hearings and Appeals (OMHA) explained that due to the “lapse in appropriations,” the office, including the administrative law judges, will be working at a reduced level of staffing. The memo goes on to indicate that, if providers have scheduled telephone hearings, they will be unaffected, and that new hearings will continue to be scheduled. Video teleconferencing hearings, the memo further notes, will not resume until federal operations are back to normal.

“The OMHA Office of the Chief Judge will operate with a few essential personnel and consequently, (and) will only be able to address the most urgent issues until normal operations resume,” the memo states. “OMHA administrative staff and all but essential managers will not be available after our orderly shutdown is complete (noon on Oct. 1).” 

Additionally, fewer recertification and initial surveys for Medicare and Medicaid providers will be completed, and that, according CMS, is expected to put beneficiaries at risk of quality-of-care deficiencies. 

CMS fraud and abuse activities also will be curtailed due to the loss of discretionary funding. 

“OIG will continue Medicare and Medicaid oversights, as those things are funded,” Evans wrote. “The work plan that was due in October will be delayed until January, but not because of the shutdown. OIG is releasing in January to better align with priorities.”

For a complete list of CMS activities being affected by the government shutdown, listed in a contingency plan developed by HHS, click here: “Contingency Staffing Plan for Operations in the Absence of Enacted Annual Appropriations.”


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Chuck Buck is publisher of RACmonitor.

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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