Medicare appeals backlog to be fixed by 2020, HHS says

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HHS Secretary Sylvia Burwell says corrective measures are reducing the number of cases.
HHS Secretary Sylvia Burwell says corrective measures are reducing the number of cases.

Federal health officials say tweaks to the system will enable them to eradicate a massive backlog of Medicare decision appeals in 2019. They made the prediction in a court brief filed in U.S. District Court for the District of Columbia in early November.

The brief asked for summary judgment in a lawsuit brought by the American Hospital Association criticizing more than 700,000 provider appeals awaiting adjudication.

HHS said it has instituted a shorter look-back period for patient status reviews, as well as efforts to lower the number of Recovery Audit Contractor appeals.

The changes “have started taking effect” and the backlog is dropping “at a rate that substantially exceeds” the pace expected by federal officials, government lawyers wrote.

It was unclear at press time how the court would rule on the new, optimistic assessment from regulators. Less than two months earlier, a federal court soundly denied HHS' request to stay the AHA lawsuit until September 2017. At the time, the court called HHS Secretary Sylvia Burwell's proposals “unlikely to turn the tide.”

The backlog has been predicted to grow to one million appeals by 2020. HHS now says that the number of unresolved appeals should “continue to decrease until it is eliminated completely by the end of fiscal year 2019.”

Meanwhile, the Centers for Medicare & Medicaid Services awarded five new contracts for its recovery audit contractor program, a move one expert suggested reflects the agency's renewed efforts to keep the heat on providers and cut improper payments.

The program has recovered an estimated $10 billion in improper payments, and extended Medicare's solvency by two years, the Council for Medicare Integrity said.