Lack of unified stance on settlements, poll finds

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Friday, October 12, 2018

YARMOUTH, Maine – It turns out, even with the huge backlog of Medicare appeals stuck at the administrative law judge level, whether or not to accept a settlement is as divisive an issue as it gets in the HME industry.

The respondents to a recent HME Newspoll were evenly divided on the issue, with 50% feeling the need to take a stand and 50% feeling the need to take the money and run.

“Why should CMS be left off the hook and rewarded for messing things up in the first place?” wrote one respondent. “No settlements.”

In November, AAHomecare plans to meet with CMS and the Office of Medicare Hearings and Appeals to continue discussing settlement options. To date, there have been two such options: an offer of 68% of the net allowed amount for acute care and critical access hospitals; and an offer of 62% for providers with fewer than 500 appeals pending at OMHA and the Medicare Appeals Council combined, with a total billed amount of $9,000 or less per appeal.

A big reason respondents feel the need to take a stand: They know they’re in the right, they say.

“Ninety percent of the rulings we receive are favorable,” wrote one respondent. “We have waited so long that I am no longer willing to accept a settlement that will be less than what we anticipate to receive from future rulings.”

For the respondents who report they are willing to settle, the most frequently cited percentages of the net allowed amount that they’d be willing to settle at were 90% and 80%.

“We are in a high time-demand business,” wrote one respondent. “The more you wait, the less you make. At this point, a settlement is a win for us. The government has endless resources and can take all the time in the world; unfortunately, we can’t.”

Other respondents echoed this notion, saying a settlement could help them keep their doors open.

“It’s hard because we have never lost a case with the ALJ, but if things don’t change quickly, we will be shutting our doors after 21 years of business,” wrote one respondent. “Yes, I would take a lower rate simply because I don’t think we will be here much longer.”

Some respondents are in a dire enough situation that they report they’ll settle for even 60% of the net allowed amount.

“I have actually received a settlement offer, as I had one patient awaiting a ruling from the ALJ,” wrote one respondent. “I took the 62% check and ran with it.”