Health Information Management

News: CMS offers deal to those willing to withdraw pending appeals

CDI Strategies, September 11, 2014

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In exchange for dropping appeals, CMS says it will provide partial payment of previously denied claims to acute care and critical access hospitals, according to a recent release. As noted in a Federal Register Notice released by the Office of Medicare Hearings and Appeals (OMHA) in January 2014, “the unprecedented growth in claim appeals continues to exceed the available adjudication resources to address [such] appeals…”
 
According to CMS, “eligible claims are those denied by a Medicare contractor on the basis that services may have been reasonable and necessary but treatment on an inpatient basis was not, that are either under appeal or within their administrative timeframe to request an appeal review, with dates of admissions prior to October 1, 2013, and where the patient was not a Part C enrollee.”
 
Facilities which choose to resolve pending (or waive appeal options) would receive 68% of the net payable amount, CMS says.
 
Facilities may not choose to settle some claims and continue to appeal others and certain hospitals may be excluded from this settlement opportunity based on pending False Claims Act litigation or investigations, according to CMS. Administrative agreement requests are due to CMS by October 31, 2014. 



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