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HHS makes headway on Medicare reimbursement appeal backlog

The Recovery Audit Contractor Program is one group that contracts with the government ot correct inaccurate Medicare payments. Those who disagree with the program’s findings can appeal the process. However, one of the biggest critiques of the appeals process is the length of time it takes to reach a resolution. As of February 2015, the appeals process took an average of 572 days.

Due to this excessive amount of time, the American Hospital Association (AHA) sued the program, stating it was required to abide by congressional mandated deadlines. The court ultimately ruled in favor of the AHA. The judge’s ruling included required backlog reductions.

Update on the backlog: The Department of Health and Human Services (HHS) recently published data on its progress based on this requirement.

Administrative Law Judges had a reported backlog of over 886,000 cases in 2015. As of the end of the fourth quarter of 2018, this number was reduced by more than half — currently at 417,198. The agency is required to eliminate the backlog by the end of the 2022 fiscal year.

Prepare for an appeal: Although the HHS has made progress with the backlog, problems with overpayment decisions remain. Health care providers that find themselves navigating a decision by the Recovery Audit Contractor or other, similar program are wise to seek representation during the process. The appeals process can entail up to five levels, ranging from an initial redetermination to an appeal to the Federal District Court. An attorney experienced in the overpayment appeals process can provide guidance throughout the case.