Medicare backlog reduces by over 99%, HHS exceeds the target set by the court

The Department of Health and Human Services (HHS) has been able to reduce the Medicare backlog of appeals per an order issued by the courts in October of last year. A decline of 99.84% was observed as of early April in the appeals backlog.

The reason that the HSS has been able to rid itself of the backlog so quickly is that its capacity to deal with appeals was doubled because of the extra money that the department was receiving from Congress. 

The hospital group has expressed great satisfaction with the situation and congratulated the HSS for its efforts. 

Melinda Hatton, AHA’s general counsel, and secretary shared in a statement, “The backlog posed a widespread threat of hospital insolvencies and patient access to care across the country, going forward AHA will remain vigilant and hold HHS to account if a backlog begins to develop again in the future.”

The Medicare Backlog Lawsuit: A Timeline

• In 2014, the AHA and three hospitals filed a lawsuit against HHS regarding long delays in hospital hearings.
• Hospitals were waiting an average of 16 months for an appeal hearing and sometimes over 5 years for a decision.
• The lawsuit was based on HHS’s inability to hold hearings and issue decisions on Medicare claims denials within 90 days of receipt.
• The backlog was causing the hospital industry billions of dollars in unpaid claims.
• In 2018, federal courts ruled that HHS had to reduce its backlog by setting up annual deadline-based targets.
• At the time of the ruling, over 420,000 appeals were identified by the court order.
• HHS met its legal obligation and nearly eliminated the entire backlog.
• As a result, the court dissolved the order forcing Medicare claims denial appeals to be dealt with within 90 days.

The court had imposed a 98% reduction target which the HSS has successfully met and surpassed. From the over 420,000 delayed appeals hearings discussed in the joint AHA and HSS filing, as of March, only 663 appeals have been initiated that were not dissolved within the set 90 days. 

76% of these 663 appeals are from the current federal fiscal year and only around 24% are from last year. Of all the appeals only one date back to 2019.

A reason for most of the current appeals waiving off the 90-day deadline is that they have been subject to tolling events or waivers of the adjudication time frame. This has been the cause identified in 623 out of the 663 backlogged cases as mentioned in an AHA filing. 

The court has dissolved the order requiring Medicare claims denial appeals to be resolved within 90 days, now that the HHS has fulfilled its legal obligation and cleared almost the entire backlog. This decision concludes the hospital industry’s lengthy legal struggle.

The Department of Health and Human Services has not yet shared an official comment on its success. 

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