Stemming from litigation, HHS says it has reduced a significant portion of its backlog of Medicare appeals.
In response to a 2018 federal court ruling in favor of hospital plaintiffs, by the end of the first quarter of 2022 HHS has reduced almost 88% of its backlog of Medicare appeals at the Administrative Law Judge (ALJ) level, according to a status report the agency provided to a federal court.
Still, 52,641 appeals remain pending at HHS' Office of Medicare Hearings and Appeals (OMHA), which is a reduction from 426,594—the total number of appeals identified in the original court order.
According to the ruling, HHS has until the end of fiscal year (FY) 2022 to eliminate the appeals in the Medicare appeals backlog. The court order gave HHS a series of goals to meet since the initial ruling, all of which have been met by the agency.
For years prior to the 2018 court ruling, HHS' OMHA was unable to keep up with the number of cases it received, leading to a mountainous backlog of pending appeals.
Thanks to a boost in appropriations from Congress, OMHA hired about 80 more ALJ staff, hoping to enable the office to catch up by the end of this year.
Although HHS is on schedule to meet its FY 2022 deadline, the court originally ordered HHS to eliminate the backlog by December 31, 2020. At the time, the American Hospital Association (AHA) accused HHS of dragging its feet. The AHA said the backlog hindered the ability of healthcare companies to do their work.
"Ending the backlog several years hence does not allow hospitals to upgrade equipment, repair aging facilities, or improve patient care now," AHA wrote in a 2018 federal court filing.
CMS has multiple, clearly defined levels of audits and appeals, and provider organizations can typically take an appeal to progressively higher levels—all the way up to the ALJ level.
Related: Medicare to Eliminate Appeals Backlog Within 4 Years, HHS Tells Judge
Amanda Norris is the Director of Content for HealthLeaders.