Audits: CMS makes concession to hospitals

WASHINGTON - Could CMS's offer to hospitals to resolve certain appeals in exchange for timely partial payment be something the agency also extends to HME providers?

Possibly, says Kim Brummett, senior director of regulatory affairs for AAHomecare, who has reached out to CMS to say, “Hey, what about us?”

“We asked if this is a sign that we could do a settlement on the DME side, and they said, 'Absolutely,'” she said. “They need to see how this works. This is the easiest thing for them to settle right now. We're going to watch what happens.”

CMS on Aug. 29 offered a settlement to acute care hospitals and critical access hospitals to resolve pending appeals of patient status denials in exchange for timely partial payment of 68% of the net payable amount.

Even if CMS were to extend a similar offer to HME providers, would they take it? Sylvia Toscano, president of Professional Medical Administrators, says many would, especially those with a significant amount of money tied up in appeals.

“I know providers who would welcome an offer like that,” she said. “It would relieve a lot of the administrative and financial burden of having to go through the appeals process. That's something that's not factored into that 68%.”

This is the second concession made to alleviate a massive backlog of appeals at the administrative law judge (ALJ) level. The first: A pilot project by the Office of Medicare Hearings and Appeals (OMHA) that brings together a provider and CMS with a facilitator to try and work out a settlement. But early reports from the project don't sound too promising.

“I was just talking to a law firm that I work with that filed a settlement conference for a DME provider,” said Stephanie Greene, chief consulting officer at ACU-Serve. “They say CMS is not being responsive about moving through the process. There's some frustration at OMHA.”

Regardless, CMS's offer and the OMHA pilot are two clear signals that something has to give with the audit program, stakeholders say.

“I think CMS is starting to see the repercussions,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “They need to do something.”