Would you drop an appeal for partial payment?


We’re used to CMS breaking news late on the Friday before a long holiday weekend. And Friday, Aug. 29, was no exception.

(It turns out Invacare took a page from CMS’s playbook and also announced late on Friday that it was selling Altimate Medical to strengthen its balance sheet and reduce debt.)

At about 3:20 p.m. EST, CMS sent out an “MLN Connects Provider eNews – Special Edition” offering a settlement to acute care hospitals and critical care hospitals to resolve appeals of patient status denials.

There has already been at least one concession made when it comes to audits and the almost guaranteed appeals that come with them: A pilot project by the Office of Medicare Hearings and Appeals (OMHA) that brings provider and CMS together with a facilitator to work out a settlement. The idea: alleviate a massive backlog of appeals—think nearly half a million of them!—at the administrative law judge (ALJ) level.

In this white flag of sorts, “CMS is offering an administrative agreement to any acute care hospital or critical access hospital willing to resolve their pending appeals (or waive their right to request an appeal) in exchange for timely partial payment (68% of the net payable amount).”

“CMS encourages hospitals with patient status claim denials currently in the appeals process to make use of this administrative agreement to alleviate the burden of current appeals on both the hospital and Medicare system,” the agency states in the bulletin.

I particularly enjoyed this headline from Modern Healthcare, whose dedicated staff reported on the news the next day, a Saturday: “CMS offers holiday sale on audit appeals.”

I have since received a few emails from HME providers, wondering why CMS isn’t extending the same offer to them. One wrote to me: “Hospitals are given preferential treatment and the rest of us are treated like second class citizens.”

Would you drop an appeal for partial payment? This provider said he would.

Of course, the bigger question, here, is why CMS is willing to acknowledge a “burden of appeals” but isn’t willing to reform the very program that got everyone into this mess in the first place? It seems to be so unwilling to do this that not only the HME industry but also the hospital industry has had to introduce legislation to try and force the agency’s hands.