November 2016
The Centers for Medicare and Medicaid Services (CMS) announced that beginning December 1, 2016, it is offering to settle certain inpatient-status claims to eligible hospitals willing to withdraw from the administrative appeals process in exchange for a one-time partial payment of 66% of the net allowable amount. This second round of settlement for hospital inpatient claims is fundamentally similar to CMS’s first round, which was made available to providers in August, 2014, but does notably differ from the first round offering in several important regards.

Five important takeaways:
  • Providers have until January 31, 2017, to file an Expression of Interest form to initiate the process.
  • CMS will compile a list of eligible claims which will be sent to the hospital to verify
  • Once in agreement, the hospital and CMS will sign an Administrative Agreement
  • The claims will be priced by the Medicare Administrative Contractors after the Administrative Agreement has been executed by both parties
  • CMS is offering to settle eligible claims for 66% of the “net allowable amount”
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