HHS Reduced Medicare Appeals Backlog by 88% During FY 2022 Q1

HHS ended the first quarter of fiscal year 2022 by reducing nearly 88 percent of the Medicare appeals backlog at the Administrative Law Judge level.

According to the Department’s status report provided to the US District Court for the District of Columbia, HHS has 52,641 pending appeals remaining at the Office of Medicare Hearings and Appeals (OMHA).

In 2018, a federal judge ruled in favor of the American Hospital Association (AHA) and ordered HHS to eliminate the 426,594 appeals in the Medicare appeals backlog by the end of FY 2022.

The court order gave HHS three additional goals to meet throughout the process of clearing the backlog. The Department was required 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 of these goals, clearing 25 percent of the backlogs by the third quarter of FY 2019, 43 percent by the second quarter of FY 2020, and 79 percent by the third quarter of 2021. The most recent 88 percent reduction by the end of the first quarter of FY 2022 has reaffirmed that HHS is on track to clear the appeals backlog by the end of FY 2022.

HHS started the first quarter of FY 2022 with 60,062 appeals in the backlog, according to the updated Medicare Appeals Dashboard.

OMHA received 10,447 new appeals during the first quarter of FY 2022, with 476 Recovery Audit Contractor-related appeals and 9,971 non-RAC appeals. More than 18,000 OMHA disposition appeals were removed, including 1,140 RAC appeals and 17,434 non-RAC appeals.

After accounting for the new appeals HHS received, the Department removed a total of 7,421 appeals, ending the quarter on December 31, 2022, with 52,641 remaining claim denial appeals.

Although HHS is still on track to meet its goal of clearing the backlog by the end of FY 2022, the recent 7,400 reduction pales in comparison to the reductions HHS made during FY 2021.

For example, HHS cleared 33,302 appeals by the end of the first quarter of FY 2021. Second-quarter reductions amounted to more than 27,000, and HHS cleared around 18,000 appeals by the third quarter. HHS ended FY 2021 by eliminating 26,001 appeals from the Medicare appeals backlog.

Even before the court ordered HHS to clear the Medicare appeals backlog, the federal healthcare agencies made strides to reduce the backlog volume.

In February 2018, CMS opened a round of low-volume appeals settlements. Under this option, the agency offered to pay providers with less than 500 claim denial appeals 62 percent of the billed amount of the claims if the provider removed all eligible claims from the appeals process.

In addition, HHS introduced the expanded Settlement Conference Facilitation process, which aimed to streamline Medicare dispute resolutions for Part A and Part B reimbursement appeals.