AHA comments on proposed changes to address Medicare appeals backlog

The Office of Medicare Hearings and Appeals’ proposal to reduce the appeals backlog at the Administrative Law Judge level is likely “to do little more than scratch the surface of the problem,” AHA told the agency today, noting that the average time to process appeals has climbed to 935.4 days. “This is movement in the wrong direction, and it is clear that merely tweaking the appeals system will not adequately address the problem,” wrote Ashley Thompson, AHA senior vice president for public policy analysis and development. AHA urged the Department of Health and Human Services to identify and implement controls to limit inappropriate claim denials by Recovery Audit Contractors, which it called “a critical component of an effective and permanent solution to the appeals backlog.” AHA also urged OMHA to continue to share data illustrating the contribution of RAC denials to the ALJ workload and backlog with HHS, Congress, providers and other stakeholders.