Dive Brief:
- The American Hospital Association and a group of independent hospitals have filed suit attempting to force HHS to meet statutory deadlines for administrative review of Medicare claims denials.
- In December 2013, the Office of Medicare Hearings and Appeals announced a temporary suspension of most new requests for administrative law judge hearings for at least two years, a move which violates a Medicare statute requiring ALJs to issue a decision within 90 days of receiving a request for a hearing, the AHA contends.
- As of February 12, the lawsuit states, 480,000 appeals were waiting to be assigned to an administrative law judge.
Dive Insight:
According to the AHA, "billions of dollars in Medicare reimbursement hang in the balance" awaiting adjudication. After all, not only are hospitals coping with existing denials, the RACs continue to hand out new denials. In an earlier letter AHA Executive Vice President Rick Pollack wrote in January to CMS Administrator Marilyn Tavenner, he argued that hospitals have been put in an untenable position in which the inability of the agency to process appeals is holding those payments hostage.