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Federal judge orders American Hospital Association to submit ways HHS can clear up Medicare appeals backlog

AHA and three of its member hospitals had sued HHS due to the long delay in processing claims appeals.

Susan Morse, Senior Editor

A federal judge has ordered the American Hospital Association as plaintiff to submit proposals on how the Department of Health and Human Services can clear up its Medicare claims backlog.

Judge James Boasberg of the U.S. District Court for the District of Columbia issued the order on March 22, according to court records.

It currently takes about three years for an administrative law judge to process an appeal of a Medicare claim. The AHA and three of its member hospitals sued HHS, saying the delay was beyond statutory requirements.

In December 2016, Judge Boasberg ordered the Department of Health and Human Services to eliminate the backlog of pending Medicare claims appeals, giving a timeline to finish by 2020.

But in August 2017, a U.S. Appeals Court overturned the order, after HHS said it would be impossible to clear up the backlog by then.

"The AHA welcomes U.S. District Judge Boasberg's recent request that we provide more details about the many recommendations that we have long suggested, including directly to HHS, that could be taken by the agency to make progress toward the reduction and further growth of the Medicare billing appeals backlog and to prevent another large influx of appeals as a result of faulty assessments," the AHA said by statement. "The heavily backlogged and broken system continues to place a strain on hospitals that have billions of dollars in Medicare reimbursement tied up in appeals." 

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