HHS says it can't eliminate Medicare appeals backlog by the end of 2020

In a court filing this week, HHS said it is unable to comply with a court order requiring it to clear its backlog of Medicare reimbursement appeals by the end of 2020.

On Dec. 5, U.S. District Judge James Boasberg granted a motion for summary judgment filed in October by the American Hospital Association in AHA v. Burwell — a suit that centers on the Recovery Audit Contractor Program.

He ordered HHS to incrementally reduce the backlog of 657,955 appeals pending before the agency's Office of Medicare Hearings and Appeals over the next four years, reducing the backlog by 30 percent by the end of 2017; 60 percent by the end of 2018; 90 percent by the end of 2019; and to completely eliminate the backlog by Dec. 31, 2020.

HHS filed a motion Dec. 15 asking the judge to reconsider his decision. HHS argued it would be impossible to reduce the appeals backlog on the schedule provided by the court without improperly paying claims, regardless of merit. In January, Judge Boasberg denied HHS' motion for reconsideration.

In a status report filed this week, HHS reiterated that it will not be able to meet the deadlines imposed by the court for clearing the appeals backlog. HHS said in its report that there were 667,326 pending appeals as of March 5. HHS projects the number of pending appeals to incrementally increase to 687,382 by the end of fiscal year 2017; 714,347 by the end of FY 2018; 788,493 by the end of FY 2019; 882,437 by the end of FY 2020; and more than 1 million by the end of FY 2021.

"Although the initiatives undertaken by HHS have significantly slowed the growth of the backlog, the significant annual reductions that this court has directed are not possible given current funding and legislative authorities," wrote HHS in its status report.

In late January, HHS filed an appeal in the case. The agency is still seeking to avoid the district court's order enforcing the plan to clear the appeals backlog by the end of 2020.

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