Health Information Management

News: AHA files civil suit related to Recovery Auditor backlog

CDI Strategies, June 5, 2014

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At the close of fiscal year 2013, nearly 5,000 claims denials remained pending review at the Department Appeals Board (DAB) – the last level of administrative review following Administrative Law Judges (ALJ) appeal. The ALJs appeals backlog stood at 460,000, according to the American Hospital Association in a civil action suit it filed on May 22, along with Baxter Regional Medical Center (Mountain View, Ark.), Covenant Health (Knoxville, Tenn.) and Rutland (Vt.) Regional Medical Center.

The suit, filed against Kathleen Sebelius in her official capacity as Secretary of Health and Human Services, asks the court to require HHS to conduct the plaintiffs outstanding denials hearings and to pay for their legal fees. 

HHS’s Office of Medicare Hearings and Appeals imposed a two-year moratorium on ALJ appeals in December, leaving 480,000 appeals awaiting assignment to an ALJ as of Feb. 12, AHA NewsNow reported. Even if the moratorium gets lifted, wait times for an ALJ hearing could negatively affect hospitals which may have hundreds of thousands of dollars tied up in the denials.

Sebelius was sworn in April 2009 and headed the HHS during the implementation of the Affordable Care Act. She gave her resignation notice in April of this year and is expected to be replaced by the current head of Office of Management and Budget (OMB), Sylvia Burwell. Burwell is expected to be confirmed by the U.S. Senate soon.

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