The Centers for Medicare & Medicaid Services is offering to pay a portion of denied claims to hospitals that drop coverage appeals in hopes of clearing a backlog of suits.
The federal agency announced that beginning Dec. 1, eligible hospitals could receive partial payment, about 66 percent, if they withdraw pending appeals. Only acute care and critical access hospitals are eligible to receive the payments.
In addition, only denied Medicare claims with dates of service before Oct. 1, 2013 and currently have appeals pending before an administrative law judge or the Medicare Appeals Council are eligible to participate in the settlement. The deadline for hospitals to file an Expression of Interest is Jan. 17, 2017.
Hospitals that choose to participate in the settlement must withdraw all pending Medicare appeals for denied inpatient claims, according to CMS, and cannot choose to withdraw some and continue to appeal other denials. CMS will host a call on Nov. 16 at 1:30 p.m. EST for providers to learn more information about the settlement process. Advanced registration is required.
CMS previously offered a similar arrangement in 2014 as the backlog of appeals began to balloon. The appeals process is often time-consuming for hospitals. A survey from the American Hospital Association found that 90 percent of the responding hospitals waited 120 days or more for a hearing in front of a federal administrative judge, the venue in which they’re likely to have the most successful appeal.
The details on the settlement were announced just before CMS was set to meet the AHA and other hospital organizations in court over a suit to compel the agency to follow mandatory deadlines for deciding appeals, according to a post from the AHA. The association’s requests include that CMS offer reasonable settlements to providers and impose penalties on recovery audit contractors for poor performance.