The Department of Health and Human Services (HHS) has largely gotten rid of a massive backlog of Medicare appeals, ending a long legal battle with the hospital industry.
The agency said in a legal filing that the Medicare appeals backlog has been reduced by 99.84% after a lawsuit filed by the American Hospital Association (AHA) and three hospitals. The hospital group lauded the agency’s progress in meeting an order back in October to tackle the appeals.
“The backlog posed a widespread threat of hospital insolvencies and patient access to care across the country,” said Melinda Hatton, AHA’s general counsel, in a statement. “Going forward AHA will remain vigilant and hold HHS to account if a backlog begins to develop again in the future.”
AHA and the hospitals sued HHS over failing to not hold hearings or issue a decision on Medicare claims denials within 90 days of receipt. AHA said in a release that facilities had to wait 16 months in some cases for a hearing and could take years to get a decision.
“The backlog was costing the hospital field billions of dollars in unpaid claims,” AHA said.
HHS issued a report that as of March 31, there were only 663 appeals initiated but not finished within 90 days. That is a far cry from a backlog of nearly 500,000 back in 2018, according to a joint AHA and HHS court filing (PDF).
The small number of long-standing appeals represented a massive 99.84% decline in the backlog, meeting a 98% reduction target imposed by the court.
“Not only has HHS surpassed the 98% reduction target, but 623 out of the 663 backlogged cases are subject to tolling events or waivers of the adjudication time frame,” AHA’s filing said, referring to events that waived the 90-day deadline.
Of the 663 appeals still in the backlog, 76% of them are from the current federal fiscal year and 24% are from 2022. There is only one appeal from 2019.
A major reason HHS was able to clear the backlog was extra money from Congress that doubled its appeal capacity. Now that the backlog has nearly cleared, AHA did not oppose dissolving an order from the court that called for the agency to severely reduce the backlog.
HHS did not immediately respond to a request for comment on the backlog.