Craneware created a “scorecard” for hospitals to use in an attempt to quantify the value of CMS’ Global Settlement for appeals of RAC denials. CMS set the deadline for hospitals to decide and file to accept the settlement offer by October 31, 2014.
See their excellent blog post, here.
See an analysis by Accretive, here.
See AHA’s checklist tool (login required).
Before taking the settlement, Craneware recommends that hospitals ask and answer the eleven questions found in the scorecard (see the FREE PDF for complete explanations):
- Does your hospital have significant dollars at risk or a high volume of outstanding appeals?
- Was your hospital’s appeal strategy based on an internal review process that appealed only strong cases, writing-off weaker cases?
- What was your recoupment strategy? Is your expected interest on a successful appeal financially substantive, or marginal?
- How badly do you need your money?
- What is the cost associated with pursuing your appeals?
- What was your prior ALJ success rate, and do you expect it to continue?
- Is time a factor?
- Is there significant value in part B payments, with a high level of surgical implants?
- What is your hospital’s volume of Medicare inpatient-only denials in appeal?
- Will taking the settlement have a substantial impact on your hospital’s Medicare Cost Report (DSH/IME/GME Payments)?
- Are you able to meet the 10/31/14 deadline for settlement?
Nicely done, Craneware!