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Ruling good news for hospitals in Medicare dispute

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An appeals court ruling has given hospital executives  new hope in a case involving Medicare’s controversial recovery-audit contractors (RACs).

The American Hospital Association and several hospitals argued in a lawsuit against the Obama administration that the appeals process for claims identified by RACs as improper is too slow and leaves Medicare payments in limbo, in some cases for years.

Modern Healthcare reported that a “lower court had dismissed the case in December 2014, saying the delay in processing RAC appeals wasn’t unreasonable enough to elicit an order from the court and that HHS and Congress should work together to resolve the issue.”

But the U.S. Court of Appeals for the District of Columbia Circuit reversed that decision Tuesday and sent the case back to the lower court for reconsideration.

The Centers for Medicare & Medicaid Services now has a backlog of 800,000 appeals, which  the Feds say are about 10 times  more than it can adjudicate annually at its current funding levels.


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