CMS Ordered To Resolve Medicare RAC Appeals Backlog By The End Of 2020

On December 5, 2016, a federal court ordered the federal Centers for Medicare & Medicaid Services (CMS) to clear a backlog of more than one million Medicare claims appeals filed by hospitals by 2020. The hospitals are appealing claims for inpatient services billed under Medicare Part A that a Medicare Recovery Audit Contractor (RAC) said could have been treated in an outpatient setting and billed under Medicare Part B. After conducting a post-payment review, the RACs demanded that the hospitals return the Part A payments. The backlog of claims has been building since 2012.

The hospitals appealed the RAC . . .