CMS updates short-term hospital claims settlement details

In an effort to reduce the amount of pending inpatient status claims appeals, the Centers for Medicare & Medicaid Services updated its offer of an administrative agreement to hospitals willing to withdraw their pending appeals in exchange for a partial payment of 68 percent of the net allowable amount, CMS announced Tuesday.

CMS encouraged hospitals with inpatient status claims in the appeals process to take the partial payment in order to relieve some of the pressure on the Medicare system, according to the announcement. Acute care hospitals, including those paid via the Prospective Payment System, Periodic Interim Payments and Maryland waiver--and critical access hospitals--are eligible to submit a settlement request. Those hospitals may not choose to settle some claims and continue to appeal others.

However, children's hospitals, cancer hospitals, long-term care hospitals, inpatient rehabilitation facilities and psychiatric hospitals paid under the Inpatient Psychiatric Facilities Prospective Payment System are not eligible to submit a settlement request.

Hospitals must file a settlement agreement request by Oct. 31 by printing, signing and scanning the administrative agreement, completing the eligible claim spreadsheet and emailing those documents to CMS, according to the announcement.

CMS will review and validate the agreements through a three-step process:

  • First, hospitals must submit their agreement. CMS will notify hospitals if there are discrepancies from the contractor eligible claims list. Proceedings on all eligible pending appeals will be stayed.

  • Second, hospitals will review discrepancies from the validation process and resubmit a revised spreadsheet within two weeks of receiving it. CMS will provide payment within 60 days and dismiss included appeals.

  • Finally, if the administrative law judge or the department of appeals board find any errors in the agreed upon settlements they can request action to take back payment for claims that were ineligible, or pay providers settlement amounts for claims pending that were inadvertently omitted from the agreement.

To learn more:
- here's the announcement
- read the settlement instructions