Providers on denied claims: ‘We’ll fight to the end’

Friday, September 12, 2014

YARMOUTH, Maine – A defiant 60% of the respondents to last week’s HME NewsPoll say they wouldn’t take up CMS on an offer to settle pending appeals in exchange for partial payment.

“I would rather go out of business than give CMS another 32% discount with all the hoops they make us go through,” said Jody Wright of Rocky Mountain Medical Equipment in Lakewood, Colo. “It’s insulting and I’m going to fight them to the end for every dollar they own my company.”

CMS on Aug. 29 offered a settlement to acute care hospitals and critical care access hospitals to resolve pending appeals of patient status denials in exchange for timely partial payment of 68% of the net payable amount.

A good number of respondents asked why they should help CMS get out of a sticky wicket that the agency itself has created, one where about half a million appeals are tied up at the administrative law judge (ALJ) level.

“Medicare has set the allowables; they should pay their portion of the allowable plus interest if the claim is not paid within 30 days,” said Kevin Jones of All American Medical Equipment & Supplies in Oklahoma City. “They are dragging this out. They should be charged late fees and interest.”

Another reason not to take CMS up on its offer, respondents say: The agency might get the wrong idea that providers can make due with 68% of reimbursement.

“Beware of giving them another tool to use against us,” said Ed Huyke of Anything Medical in Bullhead City, Ariz. “It may be used to show that we are currently being overpaid and are willing to accept and can survive with 68%. The offer is not good.”

Some providers said they would accept CMS’s offer—but not without strings attached.

“As long as this settlement wouldn’t affect the timely payment of future claims, I would accept 68% of my audited claim files at this time,” said Ronnie Sleeper of Med Supply Plus in Corinth, Miss. “Also, any settlement would have to stipulate that the claims in question are legitimately filed claims in the first place.”

For the 40% of respondents who say they would accept CMS’s offer, it would be largely a financial decision.

“The administrative cost alone of winning 100% of my over $100,000 of appeals would cost me at least $30,000,” said Mike Coughlin of CVI Medical in Dallas.


CMS offer to pay off denied claims for a 30 percent reduced amount is a sure sign that these audits or not about paying claims correctly, it's all about paying providers less. Once again the Federal Government is bending the law to fit their objectives.