CMS Offers Hospitals List of Potentially Eligible Claims

Note: Effective 10/15/2014, if a hospital is unable to produce a list of all eligible claims in a timely manner, the hospital may submit a request for a “Potentials List.”  CMS will respond within 2 business days with a list of POTENTIALLY eligible claims at Level 2 and above.  This list will not include any claims that are still in process at the Medicare Administrative Contractor and may include claims no longer eligible for one or more criteria. For example, the claim would not be eligible if the provider has already received payment for a Part B bill for the service. Providers who receive a “Potentials List” from CMS should review the list carefully and add or remove claims as needed prior to submitting the list to CMS as a full settlement request.

To request a “Potentials List” from CMS, providers should

1.  Send an email to: MedicareAppealsSettlement@cms.hhs.gov;.

2.  The subject line of the e-mail should read: “Request for Potentials List from:
(a) [insert provider name];
(b) ([insert 6 digit provider number]); and
(c) The body of the email should list each NPI associated with that Provider Number.