Medicare appeals backlog down more than 52% since 2015, HHS reports

HHS recently provided a status report on its efforts to clear the backlog of Medicare reimbursement appeals from hospitals, according to the American Hospital Association.

The number of pending appeals dropped from more than 886,000 in 2015 to 417,198 at the end of the fourth quarter of 2018, according to the AHA. Recovery Audit Contractor appeals also declined, from nearly 50,000 at the end of 2015 to 774 last year.

The HHS status report was part of a federal judge's ruling in a lawsuit filed by the AHA; Mountain Home, Ark.-based Baxter Regional Medical Center; Knoxville, Tenn.-based Covenant Health; and Rutland (Vt.) Regional Medical Center.

Last November, U.S. District Judge James Boasberg ordered HHS to incrementally reduce the backlog of appeals at the administrative law judge level. He ordered the agency to reduce the backlog by 19 percent by the end of fiscal year 2019; 49 percent by the end of fiscal year 2020; 75 percent by the end of fiscal year 2021; and total elimination of the backlog by the end of fiscal year 2022.

The judge also ordered HHS to file quarterly status reports beginning Dec. 31, 2018, according to the AHA.


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