The CMS has been pretty quiet about its Medicare appeals settlement for hospitals, and now a congressman wants the agency to retract the offer altogether.
Rep. Kevin Brady (R-Texas), who serves as chairman of the House Ways and Means Subcommittee on Health, sent a letter to HHS Secretary Sylvia Mathews Burwell (PDF) this week urging her, at a minimum, to explain how the government developed the settlement process. Brady said the committee was “shocked” to learn about the settlement through the press, and he'd prefer HHS and the CMS scrap the deal and work with Congress to come up with a “fair, transparent and conclusive settlement process.”
On Aug. 29, the CMS surreptitiously announced it would pay hospitals and health systems 68% of their inpatient-status claims sitting in Medicare's backlogged appeals process. But providers would have to agree to withdraw all of their appeals. Hospitals are able to appeal claims that recovery auditor contractors deem were improperly billed, and a majority of inpatient appeals involve patients who were treated in an inpatient setting but auditors conclude should have been treated as outpatients.