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CMS Offers Inpatient Status Denial Settlement

The Centers for Medicare & Medicaid Services (CMS) is offering a settlement to acute care and critical access hospitals that are willing to resolve pending appeals on inpatient status denials. In return for waiving appeal rights to these claims, hospitals will receive from CMS a timely, partial payment equal to 68 percent of the net payable amount. Interested hospitals should submit an administrative agreement and eligible claim spreadsheet to by Oct. 31. Upon receipt of the documents, CMS will conduct a three-step review process, starting with an initial check for information discrepancies, followed by hospital review of the identified discrepancies, culminating in payment reconciliation. If the initial data submitted by a hospital are identical to CMS’ data, CMS will countersign the original agreement and payment will be provided. If not, a second round of review will take place.

CMS is hosting a conference call Sept. 9 to provide more information on the settlement and provider eligibility. Please contact Xiaoyi Huang, JD, director of policy, at or 202.585.0127, with questions or comments.


About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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