CMS Announces Plans to Expand Settlement Options to Decrease Medicare Appeals Backlog

King & Spalding

On November 3, 2017, CMS announced that it plans to implement two appeals settlement initiatives designed to decrease the backlog of Medicare appeals pending at the Medicare Appeals Council (MAC) of the Department Appeals Board (DAB) and the Office of Medicare Hearings and Appeals (OMHA). One initiative is the low-volume appeals settlement option (LVA). This initiative is intended for appellants with fewer than 500 Medicare Part A or Part B claim appeals pending as of November 3, 2017, with a $9,000 total billed amount per appeal. CMS has not yet provided details about this initiative, but the agency announced that these eligible appeals will be settled at 62 percent of the allowed amount.

The second initiative announced will be an expansion of the Settlement Facilitation Process by OMHA. According to CMS, this initiative will be for appellants that are not eligible for the LVA. Additional information about the expansion is not yet available. Providers and suppliers are instructed to monitor the HHS Settlement Conference Facilitation website here for additional details to be released in the coming weeks.

The extent to which these two initiatives will reduce the volume of pending appeals remains to be seen and will depend on future details to be released by CMS.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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