backOn August 29, 2014, CMS issued proposed settlement terms to all hospitals pursuing administrative appeals of denied inpatient claims. Under the terms of this offer, CMS will pay "eligible claims" at 68 percent of their "net paid amount." In order to participate, however, interested hospitals must first present CMS with evidence verifying all of their eligible claims and corresponding appeal status which ultimately must be validated by CMS and its selected contractors. To qualify, all documentation must generally be provided to CMS by October 31, 2014.
The global settlement offer is a significant development that has the potential to unclog the Medicare appeals system, particularly for the massive appeal backup involving RAC denials of inpatient claims that has tied up hundreds of millions, if not billions, of dollars in Medicare reimbursement for hospitals. The terms of the global settlement offer, however, pose numerous questions that hospitals and hospital systems must carefully consider before proceeding. Given CMS's October 31, 2014 deadline, this decisionmaking will need to occur quickly.
On Friday, September 5, 2014, King & Spalding will host a Roundtable to discuss the details of CMS's offer and practical approaches to organizational evaluation of the offer. The in-person Roundtable will be take place in King & Spalding's Atlanta office, and there will be a live webinar registration option as well. Topics to be discussed during the Roundtable will include:
- What claims are eligible to be settled? Which providers?
- What process does CMS require for verifying eligible claims? How lengthy will that process be?
- How will payment be made and when?
- What are the key terms in the "Administrative Agreement" that providers must agree to in order to accept the offer?
In addition, King & Spalding attorneys will provide their understanding of how this offer will affect other areas of reimbursement such as Graduate Medical Education payments and Medicare bad debt. These are important considerations for hospitals trying to determine whether the offer is financially viable for them.
Speakers will include Sara Kay Wheeler from our Atlanta office and Mark Polston from our Washington, D.C. office.
You do not have to be a client to attend, and there is no charge.
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Questions
If you have questions concerning this Roundtable Webinar, e-mail healthcare@kslaw.com.