The CMS has made a tempting offer to hospitals as a way to clear its heavily backlogged Medicare appeals process, and many may take it to save time and money. But the deal does nothing to change a process that has become so badly bogged down that several hospitals and their trade group are suing the government over the lag.
On Aug. 29, the CMS said it would pay hospitals 68% of inpatient-status claims lingering at various stages within the Office of Medicare Hearings and Appeals. That office currently has a two-year pileup of unanswered appeals. Only acute-care and critical-access hospitals are eligible for the payment.
In return, providers must withdraw their appeals. And it's an all-or-nothing offer: Hospitals can't choose to settle some claims and pursue appeals on the rest. Once hospitals turn in their documentation and receive approval, the CMS says it will cut them a check within 60 days.
Hospitals appeal claims when they disagree with a determination from one of Medicare's four recovery auditor contractors. The RACs, which are paid a fee from Medicare to find improper payments, predominantly review hospitals for short inpatient stays that supposedly should have been billed at lower outpatient rates.