CMS Offers Settlement Agreements to Resolve Patient Status Claims Denials.
Date posted: October 7, 2014
The Centers for Medicare & Medicaid Services (CMS) is allowing hospitals to settle claims denied based on patient status for timely partial payment, constituting 68 percent of the total claims amount contested. Patient status claims eligible for settlement are those denied by contractors where a patient was admitted as an inpatient, but should have been treated on an outpatient basis. Claims eligible for settlement with CMS include those currently in the appeals process or within the timeframe to request an appeal.
Hospitals wishing to settle may enter into an administrative agreement with CMS, which must include all eligible claims in the agreement. Only acute care hospitals and critical access hospitals are eligible to enter into the process. Claims resolved through the process may only include claims with admission dates prior to October 1, 2013. Hospitals interested in applying for the process must submit an application on CMS’ website by October 31, 2014.
A description of the administrative agreement process is available at:
A list of frequently asked questions is available at:
The Centers for Medicare & Medicaid Services. “Inpatient Hospital Reviews – Update 9-26-2014.” 26 Sept. 2014 <http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html>.
The Centers for Medicare & Medicaid Services. “Frequently Asked Questions – Hospital Appeals Settlement for Fee-for-Service Denials Based on Patient Status Reviews for Admission Prior to October 1, 2013.” Hospital Appeals Settlement FAQS. 26 Sept. 2014.