CMS, inpatient rehab facilities reach settlement on pending Medicare appeals

Kelly Gooch - Print  | 

CMS is offering more settlement options for inpatient rehabilitation facilities to resolve disputes over denied Medicare claims.

The voluntary appeals settlement options are a result of two years of negotiations between the agency and the American Rehabilitation Providers Association, the Fund for Access to Inpatient Rehabilitation and the Federation of American Hospitals.

Under this voluntary global settlement, rehabilitation hospitals or units will be able to settle denied Medicare claims at any administrative appeal level, the AMRPA stated via news release.

The settlement excludes extrapolated denials and Medicare claims denied by the HHS Office of Inspector General.

CMS said it will pay 69 percent of the net payable amount for most pending appeals of denied Medicare claims associated with inpatient rehabilitation facilities; 100 percent of the net payable amount for claims denied "based solely on a threshold of therapy time not being met"; and 100 percent of the net payable amount for claims denied only based on lack of documentation in terms of justification for group therapy.

According to the rehabilitation providers association, CMS has also agreed to pay claims within 180 days of a settlement agreement being fully implemented or take on interest.

CMS said the appeal must have been filed on or before Aug. 31, 2018, to qualify for the settlement.

Read more about the settlement here.

 

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