HHS aims to reduce backlog of 700,000 Medicare appeals with new rule
A new rule proposed by HHS would attempt to reduce a large backlog of Medicare appeals cases, while encouraging new cases to be settled earlier in the process.
To reduce the estimated backlog of 700,000 cases, the 399-page proposed rule offers several major changes to the appeals process:
- Expand the pool of adjudicators in the Office of Medicare Hearings and Appeals and allow administrative law judges to focus on cases going to a hearing.
- Allow some decisions by the highest appeal level, the Medicare Appeals Council, to set precedents which will govern lower-level rulings, as determined by the chair of the Departmental Appeals Board.
- Set a new standard for minimum amount needed to lodge an appeal.
Along with those changes, the budget request for HHS in the next fiscal year asks for extra funding and new legislation to “bring our capacity for processing and resolving appeals in line with current appeal volume.” If the agency gets all its requesting, it estimates the backlog will be cleared by 2021.
The American Hospital Association said the HHS proposal doesn’t go far enough.
“We are skeptical that these proposals will do more than scratch the surface of the severe backlog in ALJ appeals that has led to hospitals facing multi-year waits for hearings,” AHA Executive Vice President Tom Nickels in a statement. “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. 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.”
The changes follow a May 2016 report from the Government Accountability Office, which recommended HHS consolidate appeals associated with repetitive claims and improving the “completeness and consistency” of the data it uses to track appeals.
The comment period on the rule runs until Aug. 29.
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.