HHS Takes Another Shot at Reducing Medicare Appeals Backlog

In an effort to clear the ever-growing Medicare appeals backlog, the U.S. Department of Health & Human Services has announced the launch of two new settlement options for providers and suppliers: a low-volume appeals (LVA) settlement and an expanded Settlement Conference Facilitation (SCF) process. LVA will be limited to appellants with a low volume of […]

Study: Medicare Appeals Process Reforms Not Enough to Eliminate Backlog

The Centers for Medicare & Medicaid Services’ (CMS) current and proposed reforms may not be enough to eliminate the appeals backlog and restore a timely and fair appeals process. That was the finding of a study published recently in the Journal of Hospital Medicine. Researchers investigated all appeals reaching level three at three facilities: Johns […]

Judge Orders HHS to Clear Medicare Claims Appeal Backlog by 2020

Four years, that’s how long a federal judge has given the Department of Health and Human Services (HHS) to clear through a huge backlog of Medicare claims appeals. The Dec. 5 ruling, from Judge James E. Boasberg grew out of a motion for summary judgment filed in October by the American Hospital Association. At issue […]

CMS offers plan (again) in hopes of clearing Medicare appeals backlog

Hospital executives who are tired of waiting for their Medicare appeals cases to be settled are being presented with an option. The Centers for Medicare and Medicaid is offering to pay hospitals 66 percent of the net allowable for short-term inpatient stays in exchange for dropping their pending appeals of denied claims. CMS recently announced […]

Will proposed rule change clear Medicare appeal claims logjam?

The Department of Health and Human Services late last month took a small step toward easing a very big problem. The agency issued a proposed rule designed to help reduce the backlog of more than 700,000 Medicare claims stuck in the appeals process. The proposed changes to the Medicare appeals process would “streamline administrative processes, […]