CMS Offers to Settle Acute Inpatient Claims on Appeal - McDermott+Consulting

CMS Offers to Settle Acute Inpatient Claims on Appeal

On August 29, 2014, CMS extended an offer with specific settlement terms to acute care hospitals who have pending appeals of denials for inpatient claims.

Earlier in the year, the Office of Medicare Hearings and Appeals (OMHA) noted the “unprecedented growth” in appeals and the insufficient resources to address those appeals. In an effort to address the volume of claims currently in the queue and awaiting adjudication as part of the appeals process, CMS has offered “an administrative agreement to any hospital willing to withdraw their pending appeals”. Eligible hospitals that withdraw their claims will receive a timely partial payment of their claims at 68% of the net allowable amount.

To get more details on the overall settlement offer from CMS including eligible hospitals, click here.

To read the terms of the Administrative Agreement, click here.