Medical Billing India

Medicare Hearings And Appeals

HHS recently said that they do not have the resources and funds to clear the pending Medicare billing appeals by the deadline of 2021, which is imposed by the court. HHS said in a report to a U.S. District Court in Columbia that they were not able to reduce the Medicare billing appeals backlog and that they have even more pending appeals than anticipated.

Last year, the court ordered HHS to fully clear all the pending Medicare appeals from various hospitals by Jan 01, 2021. This order was to resolve a long-standing dispute between the HHS and the American Hospital Association. The American Hospital Association sued HHS in 2012 claiming that they took much longer than the 90-day limit for a hospital to dispute a denied claim by the Medicare recovery audit contractors. In addition, the HHS should also follow a gradual elimination process and should file reports to the court every 90 days on the progress of the elimination process.

As per HHS, there are 667,326 pending appeals and officials believe that the number of pending appeals will further increase by three percent by the end of 2017. They also expect this number to rise by 46 percent in the upcoming years to become over one million claims by 2021.

According to the ruling by District Judge James Boasberg, HHS should decrease the logjam of pending claims by 30%, by the end of 2017. This number will rise to 60 percent by the end of 2018, and to 90 percent by the end of 2019. In December 2016 ruling, Boasberg viewed the plan that was proposed by hospitals that sued HHS as a good medium between the stagnant status quo and wide-scale settlements.

Medical Billing Services

Medicare Appeals Backlog

HHS said to the court that complying with the plan is “not possible given current funding and legislative authorities.” They claimed that the Office of Medicare Hearings and Appeals has just enough staffs to address about 92,000 appeals each year. HHS said that they have made efforts to decrease the backlog of pending Medicare claims and to slow down the backlog growth, but added that those efforts are not enough.

For instance, HHS has reopened an initiative to settle some of the appeals by hospitals, but the providers’ interest was very low than anticipated, as they expected larger payments through the appeal process. Meanwhile, HHS also needs to make sure that they are not violating their “statutory responsibilities” to settle claims.