CMS Open Door Forum Clarifies Key Points of 68% Settlement Offer to Hospitals

On September 30, the Centers for Medicare & Medicaid Services (CMS) held a Hospital & Hospital Quality Open Door Forum on a variety of topics pertinent to hospitals. CMS opened the forum with an unexpected update on CMS’ recently announced 68% settlement offer for patient status claim denials. As many providers are already aware, CMS has offered to pay 68% of the net payable value of eligible patient status claim denials in exchange for hospitals’ withdrawal of all pending eligible appeals.

While the September 30 Open Door Forum covered a variety of topics unrelated to the settlement offer, CMS clarified key points regarding the settlement offer and providers should take note.

First and foremost, CMS clarified that Part A patient status denials submitted for re-billing under Part B are eligible for inclusion in the settlement so long as the hospital has not received payment on the rebilled claim. In response to a question, CMS specified that as long as the hospital has not received Part B payment on a rebilled claim on the date that the settlement request is submitted, the claim is eligible for inclusion in the settlement process. CMS indicated that this issue will be discussed in greater detail during the October 9 Open Door Forum. Additionally, CMS indicated that it is not contemplating an extension to the October 31, 2014 filing deadline.

CMS announced that it will post additional Frequently Asked Questions on its Inpatient Hospital Reviews website later this week.

Wachler & Associates healthcare attorneys will continue to monitor the ongoing developments regarding CMS’ 68% settlement offer. If you have any questions regarding the settlement offer, its potential implications on your pending appeals, or if you need assistance in submitting a settlement request, please contact an experienced healthcare attorney at (248) 544-0888 or at wapc@wachler.com.