CMS releases details on reopened hospital appeals settlement

The Centers for Medicare & Medicaid Services today released details related to the reopened inpatient status claims settlement. While the reopened settlement appears similar to the 2014 offer, this time CMS will provide partial payment, equal to 66% of the net allowable amount of the claim, for pending administrative appeals of inpatient status denials. Only denied claims with dates of service prior to Oct. 1, 2013, with appeals pending before an Administrative Law Judge or the Medicare Administrative Council are eligible. In exchange for the partial payment, a hospital must withdraw all of its pending administrative appeals for these inpatient denials, and hospitals cannot choose to settle some claims and continue to appeal others. CMS will make the settlement process available beginning Dec. 1, and the deadline for hospitals to submit an Expression of Interest is Jan. 31, 2017. CMS will host a call on Nov. 16 to provide more details and answer questions. CMS’s announcement of the details of the reopening comes one day before the agency is scheduled to respond to the AHA’s proposed solutions to resolve the backlog of Medicare claims appeals in the federal court case brought by the AHA and three hospital organizations to compel the agency to comply with mandatory deadlines for deciding appeals. The AHA recently asked the court to require the Department of Health and Human Services to implement three “practicable solutions”: offer reasonable settlements to hospitals and other Medicare providers; delay repayment of some disputed Medicare claims and toll the accrual of interest on those claims; and impose penalties on recovery audit contractors for poor performance.