A federal judge has ordered the Department of Health and Human Services (HHS) to eliminate the backlog of pending Medicare claims appeals at the administrative law judge (ALJ) level within four years.
The American Hospital Association (AHA) filed suit in May 2014 in an effort force HHS to meet the 90-day statutory timeframe for a decision on a Medicare claim appeal at the ALJ level.
On Wednesday, U.S. District Court Judge James Boasberg granted summary judgment to the AHA and three member hospitals in their case. Judge Boasberg ordered HHS to reduce the backlog of cases 30 percent by Dec. 31, 2017; 60 percent by Dec. 31, 2018; 90 percent by Dec. 31, 2019; and fully by Dec. 31, 2020. The decision also requires HHS to file status reports with the court every 90 days.
AHA General Counsel Melinda Hatton says the ruling “is a victory for hospitals that continue to have billions of dollars in Medicare reimbursement tied up in a heavily backlogged appeals system.”