The U.S. Department of Health and Human Services (HHS) has notably surpassed the targets established by a 2018 federal court ruling in its ongoing effort to eliminate the colossal Medicare appeals backlog. The ruling, favoring the American Hospital Association (AHA), mandated HHS to eradicate 426,594 appeals in the backlog by the culmination of the 2022 Fiscal Year (FY). The court outlined additional benchmarks for the Department to achieve on its path to clearing the backlog, stipulating a 19-percent reduction by the end of the 2019 FY, 49 percent by FY 2020, and 75 percent by FY 2021.
Showcasing remarkable efficiency, HHS exceeded each of these milestones, effectuating a 25-percent reduction in the backlogs by the third quarter of FY 2019, a 43-percent cut by the second quarter of FY 2020, and a 79-percent decrease by the third quarter of 2021. The most recent accomplishment of an 88-percent reduction by the end of the first quarter of FY 2022 underlines the steadfast progression of HHS in its commitment to clear the appeals backlog within the stipulated timeframe.
According to the updated Medicare Appeals Dashboard, HHS embarked on the first quarter of FY 2022 with 60,062 appeals remaining in the backlog. This steady and successful reduction ensures enhanced functionality and efficiency in the healthcare system, facilitating expedited resolutions and alleviating longstanding concerns of countless healthcare providers.
However, this monumental progress was imperiled by the specter of a government shutdown, a consequence of ongoing political discord. The lack of a definitive deal, coupled with potential political shifts, such as the possibility of Kevin McCarthy losing the House Speaker’s gavel, raises concerns about the stability of government operations, including the management of appeals in the Office of Medicare Hearings and Appeals (OMHA). A governmental shutdown could cause the number of appeals to burgeon once again, undermining the diligent efforts to streamline the appeals process. The continuing resolution currently in place is a temporary salve, but the importance of reaching a final, lasting agreement cannot be overstated. The imminent risk of government functions grinding to a halt due to political infighting emphasizes the critical necessity of transcending partisan disagreements to ensure the uninterrupted funding of government and the continued reduction of Medicare appeals backlog.
Literature is ripe with classic phrases that seem timelessly apropos. For example, take the partial federal government shutdown. For days, the phrase repeated in the
The Medicare Advantage (MA) program has grown significantly over the past two decades, becoming a popular alternative to traditional Medicare fee-for-service (FFS). As of 2023,
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
