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Appeals backlog slowly reduced, percentage of unfavorable rulings concerning

By Home Health Line.

While the backlog of home health appeals at the Administrative Law Judge level is steadily being chipped away, data show a low reversal rate for appeals.

In 2018, 54,875 home health appeals have been dismissed. That is compared to 958 dismissals in 2017 and 731 in 2016, according to an analysis from the National Association for Home Care & Hospice (NAHC).

The dramatic jump in dismissed appeals in 2018 is primarily because of large settlements through options such as the HHS created the Low Volume Appeals (LVA) initiative and a Settlement Conference Facilitation option.

But data obtained by NAHC also show a higher rate of unfavorable decisions over the past few years.

In 2016, 7,457 decisions — about 77% — were unfavorable for agencies. In 2017 3,581 decisions — about 64% — were unfavorable.

And while just 2% of decisions in 2018 have been unfavorable, the 1,505 unfavorable decisions still outnumber the favorable decisions.

Overall, the ALJ backlog has been reduced by more than 30% since 2017, Modern Healthcare reported in August 2018. Even with this improvement, HHS says it won’t be able to eliminate the backlog completely by 2020 as ordered by a U.S. district court judge, according to Modern Healthcare.

By statute, ALJs are supposed to issue decisions on disputed claims within 90 days after a hearing request is filed. But the average processing time for appeals decided or dismissed in the third quarter of the 2018 fiscal year at the ALJ level was 1,142 days.