Court Orders AHA to Submit Proposals to Reduce ALJ Backlog

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The U.S. District Court of the District of Columbia ordered the American Hospital Association (AHA) to propose its recommendations for reducing the backlog of appeals pending at the Administrative Law Judge (ALJ) level. According to RAC Monitor,  the order signals that the district court will consider options for clearing the backlog of appeals. The recommendations must include what methods for clearing the backlog the AHA would like the court to impose, and to explain why the current procedures are insufficient. The AHA must submit its recommendations by June 22. The government must respond and provide a status update on the progress of current reforms by July 6.

The order comes as part of a 2014 lawsuit filed by the AHA and a group of hospitals against the secretary of the U.S. Department of Health and Human Services (HHS) stating that the length of time it takes to challenge a Medicare Recovery Auditor Contractor (RAC) decision at the ALJ level of appeal violates the deadlines in the Social Security Act. The statute requires that ALJ decisions must occur within 90 days of the date a request for hearing is filed. The average processing time is now more than three years.

It has been reported by RAC Monitor and other organizations that the AHA may recommend imposing financial penalties on the RACs if most of their denials are overturned on appeal; suggest the elimination of the RACs' ability to deny cases on medical judgment, transferring such cases to the Qualified Independent Contractors (QICs) for review by physicians and other healthcare professionals; and request additional settlement initiatives.