HHS: Medical appeals backlog could be 'eliminated completely' by end of FY 2019

The overwhelming backlog of Medicare claims appeals may be a thing of the past as early as fiscal year 2019, according to a court brief filed by the Department of Health and Human Services on Monday.

The brief, filed in the U.S. District Court for the District of Columbia, asks for a summary judgement in the suit between the American Hospital Association and HHS Secretary Sylvia Mathews Burwell. If the court agrees with the government, it would mean providers appealing could potentially have their day in court sooner.

In September, a federal court denied HHS' request to stay the litigation until Sept. 30, 2017, noting “... the backlog and delays have only worsened since [HHS] first sought the Court's help and the Secretary's proposed solutions are unlikely to turn the tide.” At that time, the backlog was estimated to contain around 700,000 appeals.

In the new brief, HHS reasons that its initiatives to combat the backlog — including a reduced look-back period for patient status reviews and efforts to reduce the number of incoming Recovery Audit Contractor appeals — “have started taking effect,” helping to decrease the backlog “at a rate that substantially exceeds” previously federal expectations.

The backlog has been previously forecasted to not only persist until fiscal year 2020, but grow to a million appeals by then. With Congressional action on the agency's side, HHS said, that backlog will “continue to decrease until it is eliminated completely by the end of fiscal year 2019.”

“The Secretary, moreover, has added powerful new measures in the meantime and is working on more,” the brief reads. “As a result, the backlog is finally decreasing, and at a rate that substantially exceeds the Department of Health and Human Services' previous projections.”