In reading over the recent “CMS (Centers for Medicare & Medicaid Services) Settlement Agreement Offers” published by RACmonitor.com, I was actually surprised that more folks weren’t opting for the 68-percent solution to the current appeals backlog. I was, however, even more pleased than I was surprised. I think the settlement offer is a terrible deal for providers, and even though the survey revealed that there was not a huge difference in outstanding dollars between those who would take the deal and those opting out, it was interesting that the higher the outstanding dollar amounts, the less likely it was that the organization would take the settlement.
I believe that a bit of the answer to all of this lies in the reasons given by the respondents for not participating. Around half felt that they could do better, either based on prior experience or the fact that others had reported success. Think about it: if the government was willing to settle for 68 percent, then it would make sense that most practices would come out better with an appeal. One problem is that audits cost money, win, lose, or draw. As such, there are those that will choose to settle rather than end up in the red anyway because the cost of the appeal might exceed the cost of recovery. This could be easily resolved by forcing the Recovery Auditors (RACs) to pay the practice for the cost of the audit on those findings that are reversed back in favor of the provider.