Federal Judge orders Medicare appeals backlog be resolved by 2021

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Judge:HHS must eliminate its Medicare appeals backlog—by 2021 – December 12, 2016, The Daily Briefing

A federal judge last week ordered HHS to clear a backlog of Medicare claims appeals by the end of 2020.

" The ruling comes in a lawsuit the American Hospital Association (AHA) and a group of hospitals filed in May 2014 against HHS that focuses on Medicare claims appeals filed through the Recovery Audit Contractor (RAC) program. The RAC program identifies situations in which providers allegedly inappropriately billed Medicare and recouped overbilled funds.

The lawsuit claimed the length of time it takes a provider to challenge a RAC decision violates the Medicare Act, which sets a 90-day-limit for such appeals to be settled.

HHS agreed that the review process was taking too long but said the process has slowed because administrative judges' workloads between 2012 and 2013 increased by a factor of five. The department contended that it lacks sufficient funding to remedy the issue…"

G2X TAKE: As a result of a successful lawsuit that focuses on claims appeals filed through the Recovery Audit Contractor (RAC) program, CMS is being forced to eliminate a backlog of Medicare claims by the end of 2020. Sounds good, but as this article highlights, even with additional funding, this goal may not be achievable.

We suspect that there are several firms willing to offer solutions to help expedite this effort and to take on any funding that may be diverted to meet this order.

What do you think – based on your experience, do these orders carry any additional weight? Or is this just more bluster around a known issue? Comment below.


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