Find-A-Code Focus Newsletter

CMS announced a settlement request to Inpatient hospitals!

September 02, 2014

ATTENTION In-Patient Hospitals

CMS has announced a settlement request to Inpatient hospitals for claims in appeal status! Due to the unprecedented growth in claim appeals the demand continues to exceed Medicare’s available resources. CMS has made an offer in hopes of quickly reducing inpatient status claims currently pending in the appeals process. CMS is cleaning house and has made this administrative offer to Inpatient hospitals only.

CMS is encouraging hospitals to withdraw any active claims in the appeal process, in return they (CMS) will pay 68% of the net allowable to the eligible facility types!

The administrative agreement covers admissions prior to October 1, 2013. Hospitals need to send their request to participate to CMS by October 31, 2014. However, there is an extension available if you are unable to meet this deadline.

This will be a three step process:

1) Round 1: Hospital will submit their proposed spreadsheet of eligible claims/appeals for CMS.

2) Round 2: Hospital will review the discrepancies from the first round validation process and resubmit a revised spreadsheet and Administrative Agreement for CMS validation within 2 weeks of receipt.

3) Reconciliation Process: If the ALJ or DAB later identify errors in the agreed upon settlements they will request that CMS initiate action.

The following facility types ARE ELIGIBLE to submit a settlement request:

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

The following facility types are NOT eligible to submit a settlement request:

Psychiatric hospitals paid under the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS); Inpatient Rehabilitation Facilities (IRFs); Long-Term Care Hospitals (LTCHs); Cancer hospitals; and Children’s hospitals.

Email any questions to These questions will be answered on the MLN Connects Call and will be used to create frequently asked questions and answers that will be posted to the Inpatient Hospital Reviews web page. Watch future editions of the eNews for additional updates on this topic.


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