HHS wants to cut Medicare appeals backlog: 5 things to know

HHS has released a proposed rule that would change Medicare appeals procedures, but hospitals doubt the rule will solve the significant backlog in administrative law judge appeals.

Here are five things to know about the proposed rule.

1. The proposals are part of a three-prong effort by HHS to reduce the appeals backlog and make the appeals process more efficient. As of April 30, HHS' Office of Medicare Hearings and Appeals had more than 750,000 pending appeals.

2. Under the proposed rule, OMHA would reassign a portion of the appeals to non-ALJ adjudicators. HHS estimates that expanding the pool of adjudicators would reduce the total number of appeals sent to ALJs by about 23,650 per year.

3. HHS proposed allowing HHS' Departmental Appeals Board to designate certain decisions from the Medicare Appeals Council as precedential. "We believe this would provide appellants with a consistent body of final decisions…upon which they could determine whether to seek appeals," HHS said. It would also provide direction for appeal adjudicators on repetitive policy and legal questions.

4. Regarding the proposed changes to the appeals process, American Hospital Association Executive Vice President Tom Nickels said, "We are skeptical that these proposals will do more than scratch the surface of the severe backlog in ALJ appeals that has led to hospitals facing multi-year waits for hearings." He added that the AHA found the timing of the proposals interesting, as HHS is on an extremely tight deadline to show it is making progress in resolving the backlog as part of the AHA's lawsuit challenging the ALJ delays.

5. Comments on the proposed rule are due Aug. 29.

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