HHS must wipe out Medicare backlog by 2022, judge orders
A federal judge has given HHS nearly two more years to wipe out hundreds of thousands of outstanding Medicare claims appeals.
U.S. District Judge James Boasberg in Washington ruled Thursday that HHS must eliminate the backlog by the end of fiscal year 2022. The logjam now stands at 426,594 claims.
HHS will have to meet a series of milestones as it works through the claims. Boasberg ordered that 19% of the appeals should be cleared out by the end of fiscal year 2019, 49% by the end of FY 2020 and 75% by the end of FY 2021. HHS must also file status reports every quarter on its progress.
The agency asked the judge last week not to issue a court-ordered deadline, but the ruling falls in line with HHS' internal goal for eliminating the backlog. Justice Department attorney Nicholas Cartier told Boasberg that HHS needs continued funding from Congress to help it hire administrative law judges and support staff to review denied claim appeals if it's going to meet that deadline.
Boasberg said HHS could ask for a new deadline if Congress decreases its funding.
Boasberg denied the American Hospital Association's request that he reduce interest charges on appealed claims. Currently, HHS charges 10.25% interest on claims it flagged as improper if they aren't repaid within 30 days. Appeals can take as long as three years to resolve, leaving hospitals with a potentially massive bill.
Having that cash being tied up during the appeals process can hurt struggling hospitals, the trade group said.
Historically, the HHS' Office of Inspector General has found hospitals are successful in 72% of inpatient claims denial appeals. Some hospitals have reported success rates above 95%, AHA has noted.
Boasberg said the request was beyond the scope of the lawsuit, which is focused on speeding up the appeals process.
"The agency is held to a set of deadlines, it is unnecessary—and unwise—to further specify the steps it must take," Boasberg said.
AHA said it was still pleased with Thursday's ruling. The court order will keep HHS accountable as it reduces the backlog, said Melinda Hatton, the trade group's general counsel.
An HHS spokesperson did not return a request for comment.
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