CMS to Offer New Settlement Option for Providers with Fewer than 500 Claims

The CMS announcement will be discussed in a conference call on Jan. 9, 2018.

Healthcare providers and suppliers with fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council could be eligible to participate in a new low-volume appeals (LVA) settlement offer.

The Centers for Medicare & Medicaid Services (CMS) said this week that such appellants, as long as they have a total billed amount of $9,000 or less per appeal, could be eligible if certain other conditions are met. CMS officials said the agency would settle eligible appeals at 62 percent of the net allowed amount.

Separately, OMHA will be expanding the settlement conference facilitation (SCF) process for certain appellants that are not eligible for the LVA option.

“CMS has indicated that it will be discussing both the scope and mechanics of the LVA settlement process. Although CMS made a general announcement of this process in early November, until now, CMS has been largely silent on the specifics of the program,” healthcare attorney Andrew Wachler wrote in an email to RACmonitor. “We anticipate the mechanics of the LVA settlement process will be somewhat similar, although perhaps more streamlined, than the prior hospital appeals settlements and Settlement Conference Facilitation initiatives.”

According to Wachler, the prior settlement programs were fairly limited in scope, applying only to certain hospitals with eligible patient status claims.

“We will find out (during the Jan. 9 call) whether this opportunity applies to multiple provider classes,” Wachler said. “If so, CMS’s announcement of the LVA settlement process may signal recognition by CMS that to make meaningful and continued reduction in the appeals backlog, it must continue to broaden the scope of its settlement and alternative dispute resolution programs to cover a greater quantity and variety of appellants.”

Wachler said this new settlement offer could represent a pivotal opportunity for appellants that were previously ineligible for the prior settlements or alternative dispute resolution processes to obtain a meaningful resolution on their pending appeals short of proceeding to administrative law judge (ALJ) hearings.

In its announcement, CMS said the call would not include a question-and-answer session, and it advised those planning to participate in the call to submit questions in advance at MedicareSettlementFAQs@cms.hhs.gov. CMS said speakers would discuss how to identify whether an appellant would be eligible and which of the pending appeals may be settled.

For additional information, visit the Low Volume Appeals Initiative website.