CMS Commences Round 2 Settlement Process for Inpatient Claims.

The Centers for Medicare & Medicaid Services (CMS) recently announced Round 2 of the settlement process for denied inpatient claims.  CMS contends that hospitals should have billed the denied inpatient claims as outpatient.  In September 2014, CMS offered hospitals the opportunity to settle the denied inpatient claims for partial payment.

The Round 2 process will allow hospitals to resolve claims still in contention after Round 1 of the settlement process.  Providers will have the opportunity to submit further evidence and work directly with CMS and MACs.   MACs will issue each provider a disagreement spreadsheet listing ineligible claims for settlement from Round 1.  The provider will have 14 calendar days to review and submit comments to the spreadsheet as well as submit a new administrative agreement to CMS.  Once providers and MACs come to an agreement regarding claim eligibility during Round 2, CMS will issue a new settlement payment for inclusion of those claims in the settlement process.

A description of the updated appeals settlement process is available at:

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

An updated list of settlement process steps for providers is available at:

http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Downloads/Critical_Steps_for_Providers_on_the_Appeals_Settlement_Process.pdf.

Centers for Medicare & Medicaid Services.  “Recent Updates.”  26 Mar. 2015.

Centers for Medicare & Medicaid Services.  “Critical Steps for Providers in the Appeals Settlement Process.”  20 Feb. 2015.