In an effort to encourage hospitals to take advantage of the 68 percent settlement offer for previously denied inpatient claims,  the Centers for Medicare and Medicaid Services (CMS) recently announced a new procedure. Hospitals that are unable to produce the required list of claims eligible for settlement by October 31, 2014 (this Friday), may instead submit a request to CMS for a list of potentially eligible claims (a “potentials list”).
Originally, hospitals had to submit all requisite data by October 31, 2014 in order to participate in the Settlement Offer, absent extenuating circumstances. CMS guidance now provides that hospitals will be eligible to participate as long as theyrequest a potentials list prior to October 31, 2014.  Hospitals have 14 days from the date CMS sends the potentials list to submit the full settlement request in accordance with CMS’s previous instructions.
Within approximately two business days of receiving the request, CMS will provide the hospital with a list of eligible claims that are at Level 2 of the appeals process or higher. CMS notes that hospitals should carefully review the potentials list and add or remove claims as needed prior to submitting the list to CMS as an official settlement request.  Note that requesting the list of potentially eligible claims does not obligate a hospital to participate in the settlement, and a hospital may abandon the settlement process any time prior to fully executing and administrative agreement with CMS.
Hospitals can request a potentials list by e-mail and those that are interested should visit the CMS inpatient hospital reviews website  for specific instructions on how to proceed. Interested hospitals also should consult the FAQs  as additional guidance on various issues was added as recently as this week.