CMS Offers Providers Instructions, Other Information About Patient Status Agreement

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By Michael D. Williamson

Sept. 15 — The CMS has announced new information and instructions for hospitals about a previously disclosed “administrative agreement” meant to reduce the volume of hospital patient status claims pending in the appeals process.

The Centers for Medicare & Medicaid Services on Sept. 9 released:

• an updated frequently asked questions (FAQ) document on the administrative agreement;

• instructions for hospitals seeking a settlement of their appeals through the administrative agreement; and

• a downloadable Microsoft Excel spreadsheet for hospitals that want to submit an administrative agreement application. 

In addition, the CMS held a Sept. 9 telephone call and webcast with providers to offer general information about the administrative agreement program.

The administrative agreement, announced by the CMS Aug. 29, allows any acute care hospital or critical care access hospital that elects the option to resolve their pending patient status appeals for a partial payment equal to 68 percent of the net payable amount. In addition, the administrative agreement said that facilities choosing the partial payment option waive their right to request an appeal.

At the time, the CMS said it unveiled the administrative agreement “to alleviate the burden of current appeals on both the hospital and Medicare system.” A website maintained by the CMS regarding inpatient hospital reviews said hospitals seeking the settlement must send their requests for the administrative agreement to the agency by Oct. 31.

Recovery Audit FAQs

The updated FAQ included five new questions. According to the updates, providers are not required to submit a settlement request. Those providers who don't submit a settlement request will remain in the normal appeal process, the FAQ said.

The FAQ said that the administrative agreement “is a one-time settlement offer.”

Appealed claims submitted through the administrative agreement process, the FAQ said, “are always excluded from future review by” Medicare Administrative Contractors and Recovery Audit Contractors. However, the FAQ also said that other appealed claims submitted through the administrative agreement process may be subject to audits under other programs.

According to the FAQ, four providers had submitted requests for administrative agreement settlements by Sept. 9. The FAQ said the four “all passed the ‘eligible hospital' test and have been forwarded to the appropriate Medicare contractor for validation.”

Payment Information

Meanwhile, the instructions document included information on how to complete the spreadsheet application for the program and provides information about the background of the administrative agreement and eligible providers and claims.

The instructions document also said the CMS payment for eligible claims resolved through the administrative agreement will be made in a single payment(s) per hospital provider number or per owner or operator of multiple-settling hospitals. The CMS will make the payment within 60 days of a hospital entering into a fully executed administrative agreement. The instructions also said parties' obligations under the agreement become binding upon execution of the administrative agreement.

To contact the reporter on this story: Michael D. Williamson in Washington at mwilliamson@bna.com

To contact the editor responsible for this story: Ward Pimley at wpimley@bna.com

The updated administrative agreement FAQ is at http://tinyurl.com/np6u4cm.

The administrative agreement instructions document is at http://tinyurl.com/mrz6x98.

The administrative agreement Microsoft Excel spreadsheet application is at http://tinyurl.com/oka6ofn.

Materials presented during the Sept. 9 phone call are at http://tinyurl.com/nsmznqe.