HHS Removes 79% of Medicare Appeals Backlog, On Track for FY 2022


HHS reduced the Medicare appeals backlog by 79 percent during the third quarter of FY 2021, putting the department ahead of schedule to clear the backlog.

As of June 30, 2021, the end of the third quarter of FY 2021, HHS had 86,063 pending appeals remaining at the Office of Medicare Hearing and Appeals (OMHA), according to the latest status report, acquired by the American Hospital Association. The department started with 426,594 appeals.

In 2018, a federal judge ruled in favor of AHA and its hospital plaintiffs and ordered HHS to eliminate the backlog of appeals by the end of FY 2022, providing the department with a number of goals. According to the ruling, HHS had to reduce the backlog by 19 percent by the end of FY 2019, 49 percent by the end of FY 2020, and 75 percent by the end of FY 2021.

HHS exceeded each goal and remained ahead of schedule since the court order, reducing the appeals backlog by 25 percent by the third quarter of FY 2019, 43 percent by the second quarter of FY 2020, and now 79 percent by the third quarter of FY 2021.

HHS started the third quarter of FY 2021 with 104,255 appeals, according to an updated Medicare Appeals Dashboard. The department removed 26,275 appeals by the end of the quarter, already surpassing the 75 percent goal for the end of FY 2021.

OMHA received 8,083 new appeals in the third quarter compared to the 8,172 it received in the second quarter of FY 2021. The number of new Recovery Audit Contractor-related appeals decreased between the two quarters as well, going from 400 in quarter two to 288 in quarter three.

Of the 26,232 removed OMHA disposition appeals, there were 3,514 Recovery Audit Contractor appeals, 22,718 non-RAC appeals, and 62 Settlement Conference Facilitation appeals.

The remaining removed appeals were due to combinations of cases for efficiency (162), Qualified Independent Contractor demonstrations (204), and one appeal each for Serial Claims Initiative and Inpatient Rehab Facility Settlements.

Prior to the court ruling, CMS aimed to help reduce the appeals backlog in February 2018 by opening a round of low volume appeals settlements. The agency offered to pay providers with a low number of appeals 62 percent of the billed amount of the claims if the provider removed all eligible claims from the appeals process.

In March 2018, Congress allocated more than $180 million to HHS to help the department reduce the Medicare appeals backlog. The 70 percent boost in funding helped HHS increase Administrative Judge Level staffing and expand the appeal court’s disposition capacity.

Shortly after HHS received the funding, the department projected that it would clear the appeals backlog by FY 2022, and has remained on track since then.

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