CMS Reopens Medicare Appeals Settlements

Written by Brooke Haycraft, CEMC, CFPC, CPC-H, CPC

CMS (Centers for Medicaid & Medicare Services) announced on Thursday, September 28th that they intend to reintroduce the hospital inpatient status settlement that was originally released on September 2, 2014.  The time period for hospitals to accept the settlement was October 31, 2014.

Eligible providers will now be able to settle their inpatient status claims currently under appeal using the Hospital Appeals Settlement process.

CMS’ decision to reopen this settlement is the direct result from the ongoing efforts of several groups—

·       RAC Monitor

·       American Hospital Association

·       Office of Medicare Hearings and Appeals (OHMA)

·       Andrew Wachler, healthcare attorney of Wachler & Associates, P.C.

·       Steven Greenspan, Vice President of Regulatory Affairs for Optum Executive Health Resources.

Through the collaborative effort of the above listed parties, it is believed that the reopened appeals settlement will help assist with eliminating the appeals backlog of an estimated 200,000 inpatient site-of-service claims that are currently awaiting appeal and causing delays of over two years. The reopening will also benefit hospitals that did not originally participate in the original 2014 settlement and may also guide non-eligible providers through the appeals course at a more productive pace.

Although specific details of the reopening have not been released, OHMA has supported the motion for CMS to mirror the 68% settlement that was effective in 2014.

Updates and particulars of the reopened Hospital Appeals Settlements are to be released in the coming weeks.