Judge sets timetable for HHS to clear its Medicare appeals backlog

This is essentially meaningless, but it is better than a stick in the eye….


A federal judge has agreed to set a deadline for HHS to clear out its Medicare claims appeal backlog.

The American Hospital Association and several individual hospitals have been pushing the Department of Health and Human Services to more quickly eliminate the backlog for more than four years in the courts.

The case has been juggled between federal district courts and circuit courts as judges weigh whether HHS has the ability to resolve the appeals within a set deadline. However, those capabilities changed when, as part of the omnibus spending bill approved in March, HHS was allocated $182.3 million toward the Office of Medicare Hearings and Appeals (OMHA).

Since then, HHS has projected its own deadline, which the court believes it should be able to adhere to, Judge James E. Boasberg of the District Court for the District of Columbia ruled (PDF).

The funding, Boasberg said, was a “deus ex machina” in the case. Had it not come through, a judge would have been required to determine the appropriate deadlines and impose them, something he said the courts are not necessarily positioned to do.

“While the Circuit may rely on [Immanuel] Kant, this Court believes that a set of less cerebral philosophers may provide guidance—the Brothers Grimm,” Boasberg said. “For, like their Goldilocks, this Court cannot always determine whether the soup it should brew is too hot or too cold.”

HHS estimates that it can eliminate the backlog entirely by 2022. With the additional funding, its capacity to resolve appeals will improve yearly in that window, the agency told the court.

It did warn, though, that should Congress cut back funding to OMHA, it may not be able to continue to operate at the same estimated levels. Boasberg said in the ruling that HHS can come back to the court and request changes to the timetable if needed.

The AHA said in a statement that it is “extremely pleased” to see the court set a definitive timeline for the backlog to be cleared.

“The court’s mandamus order will serve to keep HHS accountable in reducing the backlog,” General Counsel Melinda Hatton said.

Though Boasberg agreed to the timeline, he did decline to mandate that HHS follow several additional requests from the AHA.

The association had asked that the courts order HHS to lower interest rates on funds it had yet to receive from providers as it cleared the backlog and allow providers to rebill certain claims within six months of the order. Neither request, he said, was related directly to the timeline issue at hand.

He also declined to order a third piece requested by AHA: explicitly requiring the agency to continue all current programs aimed at reducing the backlog. Doing so, he argued, would hinder HHS’ ability to devise innovative ways to chip away at the appeals.

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