Hospitals Sue HHS Over Medicare Appeals

The American Hospital Association, Baxter Regional Medical Center in Mountain Home, Ark., Knoxville, Tenn.-based Covenant Health and Rutland (Vt.) Regional Medical Center have filed a lawsuit to compel HHS to meet the statutory deadlines for administrative review of Medicare claims denials.

Last December, the Office of Medicare Hearings and Appeals announced a temporary suspension of  most new requests for administrative law judge hearings for at least two years. Delays of at least two years in granting a hearing for an appealed claim violate a Medicare statute that requires ALJs to issue a decision within 90 days of receiving the request for a hearing, according to the AHA. As of Feb. 12, the lawsuit states 480,000 appeals were awaiting assignment to an ALJ.

"The stakes for America’s hospitals are high — billions of dollars in Medicare reimbursement hang in the balance," the AHA and three hospitals wrote in the lawsuit. "Deprived of the value of the services they already provided, hospitals are unable to use these funds to furnish patient care in their communities."

The lawsuit follows a letter AHA Executive Vice President Rick Pollack wrote in January to CMS Administrator Marilyn Tavenner, stating the AHA was concerned about the OMHA temporary suspension. "Hospitals have been put in an untenable position in which the nearly unfettered ability of RACs to churn out erroneous denials forces them to pursue appeals in order to receive payment for medically necessary care, while the inability of OMHA to manage the appeals process within the timeframes required by the Social Security Act holds that payment hostage," Mr. Pollack wrote.

More Articles on Medicare Appeals:
Coalition Asks HHS to Reform Medicare RAC Appeals Process
AHA Urges Congress, CMS to Address Medicare RAC Appeals Suspension
Could the Administrative Law Judge Level for RAC Appeals Disappear? 


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