HHS proposal aims to eliminate Medicare appeals backlog by 2021

The current Medicare appeals backlog could be cured by 2021 under the proposed rules, according to the U.S. Department of Health & Human Services.
The current Medicare appeals backlog could be cured by 2021 under the proposed rules, according to the U.S. Department of Health & Human Services.

The current Medicare appeals backlog could be cured by fiscal year 2021 under rules proposed Tuesday, according to the U.S. Department of Health & Human Services.

The backlog — currently sitting above 700,000 Medicare appeals cases — would take 11 years to resolve if no more appeals were filed and no changes made to the appeals system, Nancy Griswold, chief law judge of the Office of Medicare Hearings and Appeals, told Kaiser Health News.

Tuesday's proposal includes a strategies to help the agency “get a leg up on this problem,” Griswold said, including streamlining the appeals process by designating some Medicare Appeals Council decisions as precedents for lower-level decision makers to follow. That would help reduce redundant appeals and inconsistencies in interpreting Medicare policies across the board.

The HHS proposal would expand the number of available OMHA adjudicators, revise the minimum payment necessary to file an appeal and eliminate some parts of the appeals process entirely.

The HHS' latest attempts at easing the backlog follow a report from the Government Accountability Office that said the growing number of appeals “will likely persist” without more intense interventions. Those sentiments were echoed by American Hospital Association Executive Vice President Tom Nickels, who said the group is “skeptical” that the proposed rules will do more than just “scratch the surface” of the backlog.

“We are deeply disappointed that HHS has not made more progress in addressing the delays despite the more than two years since the delays began,” Nickels said. “Further, we find the timing of today's proposals interesting, given that it's just days before HHS was required to respond in court to show progress in resolving the backlog as part of our lawsuit challenging the ALJ delays.”

A spending bill that includes funds to help address the backlog was approved by a Senate subcommittee earlier this month.