CMS Says: Let's Make a Deal

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In the hours before everyone began enjoying Labor Day Weekend, the Centers for Medicare & Medicaid Services (CMS) issued an important inpatient hospital review update.

To expedite the appeals process and reduce the volume of inpatient status claims currently pending, “CMS is now offering an administrative agreement to any hospital willing to withdraw their pending appeals in exchange for timely partial payment (68% of the net allowable amount).”

While CMS says “any hospital,” the administrative agreement offer is only being extended to:

  • Acute Care Hospitals, including those paid via Prospective Payment System (PPS), Periodic Interim Payments (PIP), and Maryland waiver; and
  • Critical Access Hospitals.

Psychiatric hospitals, Inpatient Rehabilitation Facilities, Long-Term Care Hospitals, Cancer Hospitals, and Children’s Hospitals are not eligible to submit a settlement request, and certain hospitals may be excluded from the settlement opportunity based on pending False Claims Act litigation or investigations.

If a hospital proceeds with this settlement opportunity, then the hospital must be willing to settle all pending claims — it may not settle some and continue to appeal others. Detailed directions regarding how to proceed with the settlement process are included in the update.

CMS will be providing more information regarding the process on a teleconference on September 9th at 1 PM ET. Registration for this call will be posted soon at MLN Connects™ Upcoming Calls.

CMS will post and periodically update a list of Frequently Asked Questions about this settlement process and is accepting emailed questions to MedicareSettlementFAQs@cms.hhs.gov.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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