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Appeals court reverses decision over ALJ backlog

A federal appeals court reversed a lower court’s dismissal brought by the American Hospital Association and several hospitals, which would urge the Department of Health and Human Services to meet specific time frames set by Congress to review Medicare claim denials. The decision set by the court means that HHS must comply with the deadlines and give hospitals a greater capacity to urge compliance with these mandates.

This decision compliments Chairman Kevin Brady’s (R-Texas) legislation titled the Hospital Improvement Program (HIP). HIP would establish a new recovery audit contractor (RAC) reporting system to provide information on the number of RAC denials and those that are overturned at the third and fourth level of the appeals system. It is crucial that all providers, not just hospitals, be included in the language in order to include the HME industry. We must support this bill and urge Congress to include this provision into the bill.