The American Hospital Association is standing by its recommendations on reducing a backlog of Medicare appeals and suggests that critics of the recommendations may benefit from the backlog.
The recommendations, which address a backlog at the administrative law judge level, are part of a brief filed by the AHA June 22 in its case against HHS.
But the Council for Medicare Integrity has come out against the recommendations, saying they are "unconscionable" given integrity program reforms.
Melinda Hatton, general counsel for the AHA, pushed back in a July 30 opinion piece published by The Hill.
Ms. Hatton attributed the backlog largely to recovery audit contractors — who review claims and work to identify and correct past improper payments — while noting a tax filing shows the Council for Medicare Integrity is run by those very contractors.
She also took issue with a claim by council spokeswoman Kristin Walter that "the AHA brief asks the court to implement a financial penalty against the [contractors] if appeal overturns exceed 40 percent. This recommendation is clearly redundant and not nearly as strict as the 10 percent threshold currently in place per CMS."
The AHA said that claim is false.
"Instead, the contractors get a contingency fee increase — a bonus — if the overturn rate at the first level of appeal is lower than 10 percent. Not getting a bonus is far different from being penalized," Ms. Hatton wrote.
Read Ms. Hatton's full response here.
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