Reducing the Medicare appeals backlog: 4 actions over 12 months

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Over the last year, several actions have taken place to clear the backlog of Medicare claims appeals at the administrative law judge level.

Here are four, stemming from a lawsuit filed by the American Hospital Association and three member facilities:

1. HHS, in a court brief filed Aug. 3, projected that a federal appropriation will allow it to eliminate the Medicare appeals backlog by fiscal year 2022.

2. The American Hospital Association; Mountain Home, Ark.-based Baxter Regional Medical Center; Knoxville, Tenn.-based Covenant Health; and Rutland (Vt.) Regional Medical Center also filed a court brief, on Aug. 10, seeking a deadline-based remedy to address the backlog.

3. In November, a federal judge ordered HHS 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 totally eliminate it by the end of fiscal year 2022.

4. HHS has already exceeded the expectation for fiscal year 2019. On July 1, the agency told the federal court that from Nov. 1 through the end of the second quarter of fiscal year 2019, it reduced the number of pending appeals by 19.4 percent.


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