House Ways and Means Subcommittee on Health Chairman Kevin Brady (R-Texas) has sent a letter to HHS Secretary Sylvia Burwell questioning whether CMS has the authority to offer acute-care hospitals 68 percent of the net payable amount for short-term inpatient stays to help clear the backlog of Medicare appeals.
CMS is offering the settlement to "alleviate the administrative burden of current appeals on both the hospital and Medicare system," according to a CMS notice. However, Rep. Brady has "serious concerns" with the way CMS is addressing the backlog.
HHS has stated the Federal Claims Collection Act provides the statutory authority for CMS to settle claims for inpatient services that CMS contractors have determined should have been billed and paid as outpatient services.
However, according to Rep. Brady, the Act and the accompanying regulatory citation provided by HHS pertain to overpayments, while the hospital appeals pertain to a determination of a lack of medical necessity. Therefore, he is seeking "an explicit description of the HHS statutory authority to settle claims determined to be not medically necessary."
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HHS, hospitals continue to clash over Medicare appeals backlog: 5 things to know