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68% Settlement Offer — Most Will Take It

On October 29 the Office of Medicare Hearings and Appeals (OMHA) held a full-day Medicare Appellant Forum with key stakeholders both present and calling in. OMHA Chief Administrative Law Judge Nancy Griswold facilitated the event discussing the current state of the appeals program and its future.

Discussion centered on initiatives to make a system that is more productive in getting appeals managed before claims in appeal get to the level of the Administrative Law Judge (ALJ).

In the past, there has been no computer system for managing appeals through the process. A short-term computer system is being built for use over a period of about 24-months while a long-term system can be developed. The new computer system will provide a portal that will enable hospitals and health systems to log in and see exactly where their claim stands in the appeals process. One interesting point revealed was that the average time a claim now spends in the appeal process is 514 days.

This news arrives on the eve of hospital and health systems deciding whether or not they will take CMS’ settlement offer of 68% of their claims’ value. In talking with health systems, we’re hearing most say that they’ll be taking the settlement offer. All must decide by the Oct. 31 deadline.

Initially, health systems were about equally divided in terms of those who would accept the settlement, those who would not, and those undecided. As the number of the undecided gets smaller by the minute, we’re finding that those who originally decided they would not take the settlement remain very firm in their decision. They will proceed without payment until their appeals can get through the process and be decided.