Updated on: November 29, -0001

Breaking News: CMS Reopens Appeals Settlement

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Original story posted on: September 28, 2016


Steven Greenspam, Esq.


Andrew Wachler, Esq

The Centers for Medicare & Medicaid Services (CMS) announced on Thursday that it would reintroduce some form of an appeals settlement plan.

“CMS has decided to once again allow eligible providers to settle their inpatient status claims currently under appeal using the Hospital Appeals Settlement process,” the agency’s statement said. “Specific details of the settlement will be released in the near future.” 

Reaction was swift, and largely positive. 

“I am enthusiastic that CMS has realized that the initial settlement was the single largest contributor to the backlog reduction, and I applaud them for their initiative to continue to direct their energies towards methods directed to make significant and meaningful reductions to the backlog,” said Steven A. Greenspan, vice president of regulatory affairs for Optum Executive Health Resources.

Greenspan and healthcare attorney Andrew Wachler had long championed the reopening of the settlement that CMS introduced on Sept. 2, 2014. The deadline for hospitals to accept the settlement was Oct. 31, 2014. 

“I want to personally thank RACmonitor for its support of this initiative and providing a vehicle (through) which we could raise awareness of the possibility of reopening the settlement,” Wachler said in a written statement to RACmonitor Publisher Chuck Buck. “We do not have the details yet, but if (this) program mirrors the 68-percent settlement, many hospitals will benefit from this opportunity, as there are approximately 200,000 site-of-service appeals pending.” 

Wachler added that although the reopening of the settlement will not solve the problem of the delays in the appeals process, it can provide an appealing option for many hospitals that were reluctant to participate the first time around. 

“What is most rewarding is that RACmonitor listeners spoke and their voices were heard,” Wachler said. “Congratulations to RACmonitor for providing a forum to effectuate what we are hopeful will be a very positive Medicare policy for its hospital members.” 

About the Author 

Mark Spivey is a national correspondent for RACmonitor. 

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mcspivey@hotmail.com

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Read the Statement

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html

Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com, RACmonitor and ICD10monitor who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for eight years.

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