AHA, HHS present court arguments on Medicare appeals backlog: 7 things to know

The American Hospital Association and three member facilities made oral court arguments Oct. 23 in a lawsuit against HHS over the Medicare appeals backlog, according to AHA Today.

Seven things to know:

1. The hearing was before Judge James Boasberg of the U.S. District Court for the District of Columbia.

2. The AHA,  Mountain Home, Ark.-based Baxter Regional Medical Center; Knoxville, Tenn.-based Covenant Health and Rutland (Vt.) Regional Medical Center, told the judge they support court-ordered targets for reducing Medicare billing appeals at the administrative law judge level, according to AHA Today.

3. In a court brief filed Aug. 3, HHS projected a federal appropriation will allow it to eliminate the backlog by fiscal year 2022. The AHA and its member facilities argued court-ordered targets are necessary to ensure that the HHS projection is met.

4. But attorneys for HHS told the judge reduction targets for the backlog are not crucial given Congress' recent appropriation of $182.3 million to the Office of Medicare Hearings and Appeals. HHS has said it plans to use the funds to hire 80 administrative law judges and hundreds of new staff members.

HHS said the Office of Medicare Hearings and Appeals can resolve about 188,000 appeals annually, up from about 85,000 appeals last year. It projects the federal appropriation will allow it to eliminate the Medicare appeals backlog by fiscal year 2022.

5. AHA Today reported that HHS also argued that court-ordered reduction targets for the backlog are not crucial due to fewer appeals going through the system.

6. The Oct. 23 hearing comes after the U.S. Appeals Court for the District of Columbia in August 2017 overturned an order requiring HHS to incrementally clear pending appeals within five years. The ruling permitted the district court to decide whether it would be impossible to comply with the order's timetable for reducing the backlog.

According to AHA Today, the district court could reinstate the target if it finds it is possible for HHS to comply.

7. Judge Boasberg has not made a decision.      


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