Moving the HME Industry Forward

Billing/Reimbursement

HHS Won’t Meet Claims Backlog Deadline

March 27, 2017

WASHINGTON, DC – A March 7 Law360 article by Dani Kass confirms that the Department of Health and Human Services (HHS) will not be able to meet a court-imposed deadline to clear a backlog of Medicare billing appeals “unless it settles the claims without actually seeing if they have merit.” The statement came in a federal court earlier this month.

“In a required status report, HHS said its 687,382-claim backlog is projected to reach more than a million by the end of fiscal year 2021, even though the court had ordered the backlog to be eliminated by that time,” wrote Kass. “HHS had made a similar argument to the D.C. Circuit in February, saying the job can’t be done without more money from Congress or cooperation from providers.”

Newly confirmed secretary of HHS Tom Price (pictured) commented on the backlog last year during comments at Medtrade 2016.  “Three to five years they say is the average [at the ALJ level],” said Price. “If your appeal process lasts that long, then it is not a fair process…This is ridiculous. I believe we need a timeline.

“If the federal government can’t get their act together and move through the process, then it is decided in your favor after a finite period of time,” he continued. “For me, that would be six months. You can’t continue to have this going on and on and be over your heads and over your patients’ heads. It simply does not work.”