Reviving 68% settlement option could help clear Medicare claims backlog

Some policy advocates have proposed reviving the 68 percent settlement option for hospitals and health systems as a way to alleviate the current backlog of Medicare appeals.

In a recent broadcast for RACMonitor, Andrew Wachler, principal of Wachler & Associates, and Steven Greenspan, principal of The Law Offices of Steven Greenspan,  discussed the current state of the Medicare appeals system and how reinstating the 68 percent settlement rule could help hospitals and administrative law judges.

CMS implemented the settlement program in August 2014. Participating hospitals had the option to accept 68 percent of a claim's payable amount in exchange for dismissing any associated appeals. To be eligible for settlement, denied claims had to involve inappropriate patient status determinations.

 A recent Government Accountability Office report found that by implementing the program pending administrative law judge appeals dropped from 786,507 to 543,118, or a 31 percent decrease. As of April 30, HHS' Office of Medicare Hearings and Appeals had more than 750,000 pending appeals.

In June, HHS proposed a rule aimed at accelerating Medicare appeals procedures, but many hospitals fear the changes won't have a great enough impact.

Mr. Greenberg and Mr. Wachler suggested reinstating the settlement program could help to significantly reduce the Medicare appeals backlog.

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