The backlog of pending audit appeals waiting to be assigned to Administrative Law Judges (ALJs) has declined by 69 percent. The Department of Health and Human Services (HHS) reported that as of March 26, 131,961 appeals remained pending at the Office of Medicare Hearings and Appeals (OMHA).
In 2018, a federal court judge granted a motion for summary judgment requiring OMHA to eliminate the ALJ backlog by 2022. HHS is required to have a 75 percent reduction by the end of fiscal year 2021 and is on track to meet that target, it says.
Aside from a $182.3 million increase in funding by Congress in 2018, “The successful reduction of the backlog is, in part, due to CMS implementing and enforcing many alternatives to the appeals process which removed some cases entirely from the ALJ hearing process,” according to Emma Trivax, Dickinson Wright PLLC, including the Settlement Conference Facilitation program and the Targeted Probe and Educate audits.
“The increased ALJ capacity along with the new alternatives to the appeals process, create a double-edged sword for healthcare providers and suppliers. The backlog prompted CMS to restrict contractors and force them to slow down on Medicare audits. With the backlog coming to an end, these restrictions will likely be loosened, and providers and suppliers could see a substantial increase in Medicare audits. Implementation of an effective compliance program inclusive of an internal audit policy is more crucial than ever,” Trivax said in a Healthcare Michigan article.
To read the report, visit the American Hospital Association.