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HHS has reduced backlog of Medicare appeals by almost half

The reduction is linked to a federal court ruling that established annual deadline-based targets.

Jeff Lagasse, Associate Editor

Through June 26, the U.S. Department of Health and Human Services has reduced its backlog of Medicare appeals at the Administrative Law Judge level by 43%, according to a status report the agency provided to a federal court.

HHS told the court that, as of the end of 2020's second quarter, 242,995 appeals remain pending at the Office of Medicare Hearings and Appeals, which is down significantly from the initial 426,594 appeals the agency had on its plate.

WHAT'S THE IMPACT?

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The reduction, which puts the agency ahead of schedule for reducing the backlog, responds to a 2018 federal court ruling in favor of the American Hospital Association and its member hospital plaintiffs, which established annual deadline-based targets for reducing the backlog of Medicare appeals at the Administrative Law Judge level. It appears that most resolutions are coming from increased adjudications from the Office of Medicare Hearings and Appeals.

The 2018 ruling required that HHS achieve: a 19% reduction in its backlog of appeals by the end of FY2019 (a mark it hit); a 49% reduction by the end of FY2020; a 75% reduction by the end of FY 2021; and elimination of the backlog by the end of FY2022. 

The order also required HHS to file quarterly status reports. At a hearing, government counsel had argued that court-ordered reduction targets are now unnecessary because of additional agency funding to expand adjudicatory capacity and the reduced volume of Recovery Audit Contractor-related appeals currently entering the system.

This year, HHS removed 33,616 appeals in the first quarter and 31,962 in the second, though these numbers fall short of the number of removed appeals in each quarter of FY2019. OMHA dispositions accounted for 30,269 and 28,280 removals in quarters 1 and 2, respectively.

THE LARGER TREND

AHA vs. Sylvia Burwell, as secretary of Health and Human Services, has been ongoing in the courts since 2014, when the American Hospital Association asked the court to compel the federal agency to adjudicate pending Medicare reimbursement appeals by statutory-imposed deadlines.

Hundreds of thousands of appeals were languishing in a backlogged administrative process, according to court documents.

In 2016, a report from the Government Accountability Office said the backlog "shows no signs of abating." It called for HHS to improve its oversight of the process and to streamline appeals so that prior decisions are taken into account and repetitive claims are handled more efficiently.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com