Updated on: July 21, 2016

68-Percent Settlement Focus of Upcoming Town Hall Broadcast

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Original story posted on: July 20, 2016


Andrew Wachler, Esq.


Steven Greenspan, JD, LLM

With hopes that the Centers for Medicare & Medicaid Services (CMS) might reopen the 68-percent settlement solution it once offered providers to expedite the appeal process, RACmonitor is producing a special-edition broadcast on the topic scheduled to air live at noon ET on Tuesday, Aug. 9. 

The 60-minute, live “town hall” broadcast is being sponsored by Optum Executive Health Resources and will be available free of charge. The broadcast comes just weeks prior to the Aug. 29 closing of the comment period on the proposed rule from the U.S. Department of Health and Human Services designed to streamline the Medicare appeal process.

“There is growing sense of urgency to mitigate the tremendous backlog of appeals,” said Chuck Buck, RACmonitor publisher and the executive producer and program host of Monitor Mondays. “We also have a sense that if CMS becomes aware of the interest being shown by providers who have been previously foreclosed from being eligible to participate in the 68-percent settlement, they (CMS) might reopen the once-popular settlement solution.”

Participating in the broadcast will be Andrew Wachler, Esq. and Steven Greenspan, JD, LLM. Wachler is the managing partner of Wachler & Associates, and Greenspan serves as vice president of regulatory affairs at Optum Executive Health Resources.

“There is a purported 200,000 or so Part A appeals languishing at the Office of Medicare Hearings and Appeals (OMHA),” Buck said. “Some healthcare experts believe it could take as long as 11 years to work through the backlog.”

The 68-percent settlement is no longer available to hospitals with inpatient claims pending in the Medicare appeals process. These are claims that were initially denied because Medicare auditors had determined that the services performed should have been rendered in an outpatient rather than inpatient setting.

“Reopening the debate on the 68-percent settlement could significantly reduce the pending appeals backlog,” Wachler said in a news story published recently by RACmonitor. “However, whether or not it can be reopened may depend largely upon the level of interest expressed by industry stakeholders.”

According to Wachler, settling these claims could now be more attractive than ever for providers, especially when they consider the value of their resources and time associated with delays in payment while waiting for an appeal to run its course.

 “We are asking the attendees to come prepared to have their questions answered during this live town hall broadcast,” Buck said. Both Mr. Wachler and Mr. Greenspan are two nationally respected regulatory and Medicare appeal experts.”

Buck added that during the broadcast, both Wachler and Greenspan are expected to make the case for reopening the debate surrounding the 68-percent solution. He said viewers will learn more about the OMHA Settlement Conference Facilitation (SCF) Pilot Program and also what claim types are eligible for the SCF Pilot – and why inpatient status claims that were eligible for the 68-percent settlement are not eligible for the SCF Pilot.

Those interested in viewing the special-edition town hall broadcast can register online now.

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Mark Spivey is a national correspondent for RACmonitor.

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Mark Spivey

Mark Spivey is a national correspondent for RACmonitor and ICD10monitor who has been editing and writing reports for the websites for eight years.

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