AHA files brief in Medicare appeals backlog case: 9 things to know

The American Hospital Association and three member facilities filed a court brief Aug. 10 seeking a deadline-based remedy to address the Medicare appeals backlog.

Nine things to know:

1. In the brief, the AHA, Baxter Regional Medical Center in Mountain Home, Ark.; Covenant Health in Knoxville, Tenn.; and Rutland (Vt.) Regional Medical Center asked the U.S. District Court for the District of Columbia to reconsider a deadline-based remedy to reduce the backlog of Medicare billing appeals awaiting a decision by administrative law judges.

The AHA and the hospitals wrote in the brief that  "making a deadline binding and not just aspirational will keep HHS from backsliding" and "entering a deadline with fixed reduction targets each year along the way gives HHS an aggressive goal and ensures steady interim progress."

2. In the brief, the AHA and the hospitals said they also continue support for non-deadline remedies, including Recovery Audit Contractor program reforms, such as imposing a financial penalty on recovery audit contractors with a high turnover rate at the administrative law judge level, and requiring HHS to "demonstrate its commitment to good-faith, evidence-based settlements by documenting its settlement activity under seal."

3. The brief is the latest action in a lawsuit brought by the AHA and hospitals. The lawsuit focuses on resolving Medicare claims appeals at the administrative law judge level within 90 days.

4. Once the lawsuit was filed, a federal judge ordered HHS to incrementally clear pending appeals by the end of 2020.

5. HHS asked Judge James Boasberg with the U.S. District Court for the District of Columbia to reconsider the order, but that request was denied in January 2017.

6. After HHS appealed the decision, the U.S. Appeals Court for the District of Columbia overturned the order in August 2017, permitting the lower court to decide whether, as HHS contended, it would be impossible to comply with the order's timetable for reducing the backlog.

7. In February, the AHA asked the U.S. District Court for the District of Columbia to reinstate the HHS deadline for clearing the appeals backlog, saying HHS "has not shown it is impossible to clear the backlog — minus, perhaps, some claims with serious program-integrity concerns — within five years."

8. Judge Boasberg then called on the AHA to "elaborate and expand upon ... recommendations it has made over the course of litigation for clearing the backlog," according to the AHA.

9. The AHA provided its feedback in a brief filed June 22, which was reiterated in the Aug. 10 brief. 

Ayla Ellison contributed to this report.

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