On November 1, 2018 a judge ruled that the Department of Health and Human Services (HHS) must eliminate the Medicare appeals backlog by 2022. At the time of the ruling, there were more than 426,000 unresolved Medicare disputes.
While the backlog must be cleared by 2022, the court ruling also stipulated that 19% be cleared by the end of fiscal year (FY) 2019, 49% must be cleared by the end of FY 2020, 75% by the end of FY 2021, and the remainder by the end of FY 2022.
In order to reach this goal over the next four years, Congress awarded HHS a 70% increase in funding, which is equivalent to a $182.3 million increase, RevCycleIntelligence reported. This funding increase will allow HHS to increase administrative law judge staffing by about 80 judges and 600 new positions over the next 14 months.
If Congress reduces HHS’ funding to a degree where they would be unable to comply with the ruling, the judge’s decision allows HHS to request a modification of the order.
Though the judge denied the American Hospital Association’s (AHA) requests to reduce interest charged on appeals, allow providers to rebill their claims for six months following the issuance of the court’s order, and require that HHS maintain its current settlement programs, the AHA still expressed approval of this ruling.
DMEPOS is the largest contributor to the appeal backlog, accounting for 57% of all appeals pending for 2018. In fact, 7 of the top 10 appellants at OMHA are DME suppliers.