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HHS final rule takes aim at Medicare appeals backlog: 5 things to know

HHS released a final rule aimed at decreasing the Medicare appeals backlog on Jan. 17 following a court order for the agency to resolve the backlog by Dec. 31, 2020, according to a JDSupra report.

Here are five key notes:

1. There were more than 650,000 Medicare appeals backlogged in September 2016, forcing providers to wait more than 900 days for an administrative law judge hearing; the statutory deadline to receive the administrative law judge decision is 90 days.

2. The final rule details the agency's three-pronged approach to the issue, which includes adding available Office of Medicare Hearings and Appeals adjudicators, streamlining processes and allowing attorney adjudicators to handle some of the appeals.

3. The changes are expected to allow the ALJs to "focus more on substantive issues in the hearings," and give the Departmental Appeals Board, Medicare Appeals Council authority to handle the next level of appeals.

4. HHS established precedent at the Departmental Appeals Board, Medicare Appeals Council level with the hope of decreasing the number of appeals on the front-end because the providers will be able to make decisions about which claims denials to appeal.

5. The final rule does not address the Recovery Audit Program, which some feel aggressively audits and could be one of the reasons for the huge backlog.

The final rule will go into effect March 20.

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