The Department of Health and Human Services through June 30 has reduced by 25% its backlog of Medicare appeals at the Administrative Law Judge level, according to a status report the agency recently provided to a federal court.
The reduction, which puts the agency ahead of schedule for reducing the backlog, responds to a federal court ruling last year in favor of the AHA and its member hospital plaintiffs that established annual deadline-based targets for reducing the backlog of Medicare appeals at the ALJ level.
HHS this month reported that “[f]rom November 1, 2018 through the end of the third quarter of FY 2019, there has been a net reduction of 108,340 appeals pending at OMHA with a total of 318,254 appeals pending at OMHA by the end of the third quarter, which is a 25.4% reduction from the starting number of appeals identified in the Court’s November 1, 2018 Order (426,594 appeals).”
It appears that most resolutions are coming from increased Office of Medicare Hearings and Appeals resolutions and settlement facilitation conferences. In addition, recovery audit contractor receipts remain low, with only 97 reported in the third quarter of fiscal year 2019.
Last year’s order required that HHS achieve the following reductions from its own currently projected FY 2018 backlog of 426,594 appeals: a 19% reduction by the end of FY 2019; a 49% reduction by the end of FY 2020; a 75% reduction by the end of FY 2021; and elimination of the backlog by the end of FY 2022.

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