HHS finalizes rule to clean up Medicare claim appeals process

The U.S. Department of Health and Human Services will take aim at its massive Medicare claim appeals backlog with a rule finalized on Friday.

Providers in many healthcare sectors, including long-term care, have complained about appeals going unheard, causing financial hardships in the process.

The rule, first proposed in June, will take a “three-prong approach” to clearing up the backlog of appeal requests, which increased 1,222% from fiscal years 2009 to 2014, the agency said. Included in the rule are plans to expand the pool of Office of Medicare Hearings and Appeals adjudicators, and streamline the appeals process to less time is spent on “repetitive issues and procedural matters.”

The final rule also will give authority to attorneys to issue decisions on appeals in cases that don't require an administrative law judge hearing. That move will send an estimated 24,5000 appeals each year to attorney adjudicators, rather than into the costly and time-consuming ALJ process.

The finalization follows a lengthy court battle between HHS and the American Hospital Association, which will require the agency to eliminate the backlog within four years in accordance with court-appointed deadlines — a feat that isn't possible without additional funding or resources, HHS has argued.

The agency's final rule was to be published in the Federal Register on Tuesday.