CMS held a conference call on Sept. 9 to provide more details on its previously announced offer to pay hospitals 68 percent of the net payable amount for short-term inpatient stays, in an effort to help clear the backlog of Medicare appeals.
Here are 10 things to know about CMS' offer.
1. Acute care hospitals and critical access hospitals are the only types of providers that are permitted to take part in the settlement process with CMS.
2. During the conference call, CMS said it does not have any interest in expanding the settlement offer to include specialty hospitals, including children's hospitals or those that specialize in cancer care, according to a Law360 report.
3. The settlement does not apply to any short-term hospital admissions that occurred after Oct. 1, 2013.
4. Claims subject to pending appeals are eligible for the settlement. This includes claims where an administrative law judge has ruled against a hospital, and the hospital is appealing to a higher level, according to the report.
5. To begin the settlement process, hospitals will submit spreadsheets including all claims they believe are eligible for the settlement offer.
6. All initial settlement requests from hospitals are due to CMS by Oct. 31.
7. After a hospital submits its spreadsheets, Medicare contractors will add additional eligible claims and subtract those that do not qualify for the settlement, according to the report.
8. Hospitals will have 14 days after the contractors respond to their initial submissions to decided whether they agree with the contractors' assessments.
9. All appeals are stayed during settlement negotiations. However, if a hospital chooses to step away from the settlement, it will still have its same placement in the Medicare appeals line.
10. Once a hospital applies for the settlement with CMS, it is no longer permitted to continue attempting to collect money from patients concerning claims submitted for settlement, unless the patients have previously entered into a repayment plan with the hospital, according to the report.
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