HHS: Medicare Appeals Backlog Will Be Worse by 2021

After being directed by a court order to clear out the Medicare backlog of home health care claims appeals, the Department of Health and Human Services (HHS) is predicting the backlog will only grow by the time the backlog is meant to be eliminated.

In December last year, HHS was ordered to clear its backlog of pending Medicare claims appeals—many of which are home health care appeals—gradually by 2021. HHS declared the timeline “impossible” at the end of last year. The agency is now predicting that instead of clearing the backlog, the number of appeals will top 1 million by the end of fiscal year 2021, according to court records. By the end of fiscal year 2017, the number of Medicare appeals in the backlog is anticipated to be 687,382.

The revised projection was due to several factors, according to HHS Secretary Tom Price. The agency said it would not be able to clear the backlog and settle claims “with regard to the merits of those claims,” court records show.


The agency also said that there are a lack of legislative actions to combat the backlog, as ”the 114th Congress adjourned without taking actions that would impact the backlog,” court records show.

HHS was ordered to cut the shockingly large backlog of Medicare claims appeals—some of which date back several years—after a report published in June 2016 revealed the extent of the problem and the harm to health care providers awaiting decisions on ongoing appeals processes. The agency sought to have that ruling reconsidered in early December 2016, citing its inability to hit the targets set by the judge at the time.

Written by Amy Baxter


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