News: AHA asks court to order HHS to implement three appeals backlog solutions

The American Hospital Association (AHA) asked a federal judge to require the Department of Health and Human Services (HHS) to implement three “practicable solutions” to the Medicare claims appeals backlog, according to a motion filed on October 14.

The solutions at the administrative law judge level include:

• Offer reasonable settlements to hospitals and other Medicare providers
• Delay repayment of some disputed Medicare claims and offer relief to hospitals that experienced reduced Medicare revenue because of a denial or were never paid by a Medicare Administrative Contractor
• Impose penalties on recovery audit contractors for poor performance

The HHS secretary has the authority to implement each reform, which together will target the existing backlog of appeals and reduce the number of future appeals, says the AHA.

The case, brought by the AHA and three member hospitals, states the HHS failed to meet statutory deadlines for processing Medicare claims appeals. At an October 3 status hearing, the judge indicated he was prepared to compel the government to meet the statutory deadlines for processing Medicare claims appeals, but first ordered additional briefing on what remedial steps HHS should take to reduce the claims backlog.

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