CHA News Article

CMS Offers Administrative Agreement Settlement in Effort to Reduce ALJ Backlog
Hospitals may receive 68 percent of payments currently pending in appeals

In an effort to reduce the volume of inpatient status claims currently in review, the Centers for Medicare & Medicaid Services (CMS) announced last week that it is offering an administrative agreement to any acute care or critical access hospital willing to withdraw its pending appeal(s) in exchange for “timely” partial payment consisting of 68 percent of the net allowable amount. Claims eligible for this program are those currently pending appeal of inpatient-status claim denials by Medicare contractors on the basis that services may have been reasonable and necessary but treatment on an inpatient basis was not — with dates of admission prior to Oct. 1, 2013 — and where the patient was not a Part C enrollee. The CMS announcement provides the forms required to enter into such an agreement, instructions for completing, and an explanation of the process. Hospitals wishing to participate in the program should email their request and eligible claim spreadsheet to by Oct. 31. Providers not able to meet the deadline may request an extension from CMS.

CHA continues to review this agreement and its implications for hospitals. CHA urges hospitals to carefully evaluate the impact of entering into such an agreement and to review CMS’ Administrative Agreement form with legal counsel.