September 25, 2014

AHA Releases Hospital Tools to Evaluate CMS Appeals Settlement Offer

On Aug. 29, the Centers for Medicare & Medicaid Services (CMS) issued a notice offering a settlement of hospital appeals of short stay denials. CMS's intent in offering the settlement is to address the significant backlog of Medicare appeals at the administrative law judge (ALJ) level, which resulted in the Office of Medicare Hearings and Appeals suspending assignment of appeals to ALJs for at least two years.

Each hospital should evaluate carefully the terms of the offer and the hospital's own situation in making a decision about whether to pursue the settlement offer. To assist with this analysis, the AHA commissioned a national accounting firm to develop a tool to help hospitals compare the settlement they might expect to receive under CMS's offer with what they might recover if they choose to continue the appeals process for claims eligible for the settlement. AHA members recently received a Special Bulletin with more details on the tool and CMS's offer.

Questions should be directed to AHA Assistant General Counsel Lawrence Hughes at (202) 626-2346 or Senior Associate Director for Policy Melissa Jackson at (202) 626-2356. (Courtesy of the American Hospital Association)