“House Ways & Means health subcommittee chair Kevin Brady (R-TX) questions HHS’ authority to settle hospitals’ appeals of denied inpatient claims and is urging HHS Secretary Sylvia Burwell to retract what he views as an “ill thought” settlement process. Brady wants Burwell to work with lawmakers to come up with a different “fair, transparent and conclusive settlement process.”
Brady wrote to Burwell Tuesday (Sept. 16) that he is dismayed by HHS’ reluctance to work with the committee on an equitable settlement process that is fully legal, adding that the “lack of engagement makes it challenging for the Congress to solve the current appeals problems and prevent similar problems in the future.”
CMS announced late last month (Aug. 29) that it will pay hospitals 68 percent of denied inpatient status claims in the appeals queue if hospitals take them out of the backlogged appeals process. The agency has been encouraging hospitals to take advantage of the settlement to “alleviate the burden of Medicare appeals on both the hospital and Medicare systems,” according to the CMS website.
Hospitals should decide whether to participate by the end of October, and CMS in a Frequently Asked Questions document released Sept. 9 says that four hospitals have already stepped forward to take the settlement offer. The document also states that this is a one-time offer from CMS.”