CMS Offers RAC Settlement Option to Hospitals

The Centers for Medicare & Medicaid Services will provide any acute care or critical access hospital willing to withdraw their pending recovery audit appeal of claims with a "timely partial payment" of 68 percent of the disputed claims' net allowable amount. The CMS Office of Medicare Hearings and Appeals has a significant backlog of hospital inpatient claims appeals, and the agency is encouraging hospitals to "make use of this administrative agreement mechanism to alleviate the administrative burden of current appeals on both the hospital and Medicare system." The eligible claims, according to CMS, are appeals pending for inpatient-status claim denials by Medicare contractors on the basis that services may have been reasonable and necessary, but treatment on an inpatient basis was not, with dates of admissions prior to Oct. 1, 2013. Hospitals that wish to appeal should do so by Oct. 31, 2014, or request an extension. CMS will review the spreadsheets of claims and appeals submitted by hospitals, then the hospitals will review any discrepancies and resubmit spreadsheets as needed, and finally the appeals will be dismissed and the hospitals will be paid.