Eligible Providers
Only acute care hospitals and critical access hospitals may participate in the Settlement Process. The following providers are not eligible to participate:
- Cancer hospitals;
- Children’s hospitals;
- Inpatient rehabilitation facilities;
- Long-term care hospitals; and
- Psychiatric hospitals that are paid under the inpatient psychiatric facility prospective payment system.
CMS may exclude eligible providers from participating in this Settlement Process if they are subject to pending False Claims Act litigation or investigations.
Eligible Claims
Only the following claims are eligible:
- Claims for dates of admissions prior to October 1, 2013;
- Claims for patients that were not Medicare Part C enrollees; and
- Claims that are pending appeals of inpatient-status claim denials, which were rejected by Medicare contractors, including RACs.
An eligible provider may select the eligible claims it would like to settle, while continuing to appeal certain other claims.
For more information regarding the Settlement Process, please contact Mark Gallant, Chris Raphaely, or Ryan Blaney.