Tag: Appeals Backlog

WASHINGTON - The Department of Health and Human Services has reduced the backlog of Medicare appeals at the administrative law judge level by 25% through June 30, according to a status report provided to a federal court and obtained by the American Hospital Association.The status report is part of a federal court ruling last year that established annual deadline-based targets for reducing the backlog of Medicare appeals at the ALJ level.From Nov. 1, 2018, through the end of the third quarter of fiscal...

YARMOUTH, Maine - It turns out, even with the huge backlog of Medicare appeals stuck at the administrative law judge level, whether or not to accept a settlement is as divisive an issue as it gets in the HME industry.The respondents to a recent HME Newspoll were evenly divided on the issue, with 50% feeling the need to take a stand and 50% feeling the need to take the money and run.“Why should CMS be left off the hook and rewarded for messing things up in the first place?” wrote one respondent....

WASHINGTON - CMS recently announced a low volume appeals settlement for Part A and Part B appeals at the Office of Medicare Hearings and Appeal and the Medical appeals Council. The option is limited to appellants with less than 500 appeals and each individual appeal must total $9,000 or less. The settlement is for 62% of the allowed amount minus the copay, according to a bulletin from AAHomecare. As of August 2017, OMHA had 591,962 total appeals pending—an increase of 300% since 2016. The number...

NEW YORK - The D.C. Circuit on Aug. 11 ordered a federal judge to take a deeper look at whether or not the U.S. Department of Health and Human Services can clear a backlog of about 600,000 appeals by 2021, while still protecting taxpayer dollars, according to Law360. The ruling is a setback for the American Hospital Association, which has been fighting HHS in court over the backlog for several years. The D.C. Circuit, in a 2-1 ruling, said the judge didn't properly evaluate HHS's assertion that it...

WASHINGTON - Industry stakeholders are throwing their support behind expanding a demonstration project that allows providers to speak with reconsideration professionals by phone to try and resolve their appeals.AAHomecare on Feb. 22 submitted comments to CMS, recommending that the agency also consider applying the phone demo to the first level of appeals. Currently, it applies only to the second level of appeals.“Although the demonstration at the second level of appeals has been a positive...

WASHINGTON - The Department of Health and Human Services has published a final rule that addresses the massive appeals backlog. The proposed rule, published in July, established precedential authority to the fourth level of appeals and created attorney adjudicators at the third level of appeals. The final rule did not have major modifications. It will go into effect March 20.

WASHINGTON - The U.S. District Court for the District of Columbia stands firm that the Department of Health and Human Services must implement procedures to curtail a massive appeals backlog in a timely fashion.Judge James Broasberg on Jan. 4 refused to rescind his previous order on Dec. 5 requiring the agency to eliminate the 650,000-claim backlog before 2021. HHS had argued that it would only be able to meet such a deadline by paying for claims without regard to merit.The court was not unsympathetic...

WASHINGTON - The wait time for DME appeals at the administrative law judge level has increased by nearly 25% during the first half of 2015, according to an analysis released by AAHomecare.“It is painfully obvious that this system is broken, but no measures are being taken to fix the root of the problem,” said Kim Brummett, vice president of regulatory affairs at AAHomecare, in a release.Despite reports from the Office of Medicare Hearings and Appeals indicating improvement, the average...