Last Chance: New Way for Hospitals to Participate in the CMS Settlement Offer for Inpatient Claims

In an effort to encourage hospitals to take advantage of the 68 percent settlement offer for previously denied inpatient claims, [1] the Centers for Medicare and Medicaid Services (CMS) recently announced a new procedure. Hospitals that are unable to produce the required list of claims eligible for settlement by October 31, 2014 (this Friday), may instead submit a request to CMS for a list of potentially eligible claims (a “potentials list”).

Originally, hospitals had to submit all requisite data by October 31, 2014 in order to participate in the Settlement Offer, absent extenuating circumstances. CMS guidance now provides that hospitals will be eligible to participate as long as they request a potentials list prior to October 31, 2014. [2] Hospitals have 14 days from the date CMS sends the potentials list to submit the full settlement request in accordance with CMS’s previous instructions.

Within approximately two business days of receiving the request, CMS will provide the hospital with a list of eligible claims that are at Level 2 of the appeals process or higher. CMS notes that hospitals should carefully review the potentials list and add or remove claims as needed prior to submitting the list to CMS as an official settlement request. [3] Note that requesting the list of potentially eligible claims does not obligate a hospital to participate in the settlement, and a hospital may abandon the settlement process any time prior to fully executing and administrative agreement with CMS.

Hospitals can request a potentials list by e-mail and those that are interested should visit the CMS inpatient hospital reviews website [4] for specific instructions on how to proceed. Interested hospitals also should consult the FAQs [5] as additional guidance on various issues was added as recently as this week.

If you have any questions or need assistance, please contact Linda A. Baumann, Hillary M. Stemple, or the Arent Fox professional who handles your matters.

[1]Linda A. Baumann and Hillary M. Stemple, Hospitals Face Important Decision on Whether to Accept CMS Settlement Offer for Certain Claims on Appeal, Oct. 8, 2014, available here.
[2]Centers for Medicare and Medicaid Services, FAQs: Hospital Appeals Settlement for Fee-For-Service Denials Based on Patient Status Reviews for Admission Prior to October 1, 2013, Updated Oct. 27, 2014, available here.
[3]For example, the potentials list will not include any claims that are still in process at the Medicare Administrative Contractor, and may include claims that no longer meet all settlement criteria (which we discussed in a recent Arent Fox client alert).
[4]Centers for Medicare and Medicaid Services, Hospital Inpatient Reviews, available here.
[5]See footnote 2 supra.
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