Efficient Reduction of Medicare Appeals Backlog Continues Despite Political Tensions

Efficient Reduction of Medicare Appeals Backlog Continues Despite Political Tensions

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.

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Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

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