HHS Ordered to Eliminate Medicare Appeals Backlog

November 7, 2018 | Cassandra Rivais DiNova | Hospitals | Litigation | Medicare and Medicaid

Healthcare facilities waiting to hear back on Medicare appeals received good news on November 1, when the U.S. District Court for the District of Columbia ordered the U.S. Department of Health and Human Services (HHS) to eliminate its backlog of 426,594 Medicare appeals by 2022. The order, in American Hospital Association, et al., v. Azar, 2018 U.S. Dist. LEXIS 186853 (D.C. 2018), requires HHS to achieve “a 19% reduction by the end of FY 2019; a 49% reduction by the end of FY 2020; a 75% reduction by the end of FY 2021; and elimination of the backlog by the end of FY 2022.”

The AHA started the lawsuit against HHS four years ago in an effort to eliminate long delays in the administrative appeals process for Medicare reimbursement claims. Given a recent $182 million appropriation from Congress for this task, the Court held that elimination of the backlog is possible.

The Court’s opinion stated, “Health and welfare are indisputably at stake: hospitals with ‘money tied up in the appeals process’ have a difficult time maintaining facilities and procuring supplies and may even ‘avoid admitting certain types of patients’ whose treatment might be the subject of a lengthy review process.” According to HHS’s Office of Inspector General, 72% of hospitals’ inpatient claims denial appeals are successful.

HHS must file quarterly status reports with the Court beginning on December 31, 2018.

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