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Medicare Appeal Backlog Could Be Cleared by 2019, HHS Claims

By Matthew Loughran | November 8, 2016 10:28AM ET

Nov. 8 (BNA) – The multi-year backlog of Medicare administrative appeals could be cleared up by the end of fiscal year 2019, according to an HHS filing in federal district court yesterday.

The Health and Human Services Department asked the U.S. District Court for the District of Columbia not to intervene in the appeals process, seeking dismissal of a case brought by the American Hospital Association and three regional hospitals. The hospitals want a court order requiring the HHS to implement a series of procedures designed to curtail the extensive appeals backlog they say is caused by the Recovery Audit Contractor program.

The HHS recently reopened a settlement program that offers certain hospitals an opportunity to receive nearly two-thirds of their contested reimbursement in return for dropping their appeals. The agency told the court this program, when combined with a number of other administrative and legislative actions, could reduce the appeals backlog to zero by 2019. A bill currently pending in Congress would add $1.3 billion to the appeals budget over 10 years.

Am. Hosp. Ass’n v. Burwell, D.D.C., No. 1:14-cv-851, opposition brief filed 11/7/16

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