Remember the 68 percent solution :: Reliant Rehab

Remember the 68 percent solution

June 11th, CMS quietly announced that as part of its 68-percent solution, it had paid out about $1.3 billion to 1,900 hospitals that had agreed to the settlement. 

The announcement included references to a report which suggests “the average payment to a hospital was about $684,000. There was no data given about the range in size of payments, although assuming that a mix of large and small hospitals participated, it is likely that the range was substantial.”

The announcement did not indicate the number of claims that were resolved or the percentage of pending administrative law judge (ALJ) appeals that are now out of the lengthy appeal queue leaving providers curious about how this move really will improve the backlog.

Modern Healthcare reports, “that the settlement involved 300,000 claims. The U.S. Department of Health and Human Services (HHS) website indicates that in the 2013 fiscal year, the latest year for which data is available on the website, appeals were filed for 654,580 claims. During the prior fiscal year, an additional 293,000 claims were appealed.”

By using historical claims volume data, one can assume “it would mean that there is an average of 323,000 unresolved cases from those years, or about double the number filed in 2010. In short, the delays at the ALJ level may subside, but it appears that the ALJs will continue to have a very large caseload.”

So who has gained from this?  It would seem only CMS has won by lowering the reimbursement by $611 million through the 68-ercent solution.

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