Office of Medicare Hearings and Appeals To Hold Open Door Call on Upcoming Expansion of Settlement Conference Facilitation Program

by Arnall Golden Gregory LLP

In preparation for the upcoming expansion of its Settlement Conference Facilitation (SCF) program, the Office of Medicare Hearings and Appeals (OMHA) has directed interested providers and suppliers to review the SCF Expansion Frequently Asked Questions page on the agency’s website and to register for an Open Door Call scheduled for May 22, 2018. For providers and suppliers mired in the backlog of appeals at the Administrative Law Judge level, the SCF program is an alternative dispute resolution process which promises a potential payment resolution for those Medicare Part A and Part B claims, which were appealed to OMHA or the Medicare Appeals Council (Council) on or before November 3, 2017, as long as the ALJ hearing has not yet been scheduled or conducted.

For providers and suppliers whose primary focus is cash flow, settlement conferences are a viable alternative as the focus of discussion is limited to negotiation about payment. Providers and suppliers will not have the opportunity in SCF to make medical necessity arguments, policy arguments, or to argue the strength of the Medicare claims at issue. Similarly, the role of the OMHA-employed facilitator during the conference is to help the parties move towards resolution of the claims, and the facilitator does not play a role as a fact finder or make any determinations based on the merits of the claim. While neither party is required to settle the claim at issue, if the parties are able to reach a resolution, OMHA has explained that the settlement agreement will not specify an actual dollar amount, but a percentage of the Medicare approved amount at issue. In addition, unlike other settlement programs offered by the Centers for Medicare or Medicaid Services (CMS), SCF has no prescribed settlement percentage and OMHA has indicated that the agreement is unique to each appellant.

Historically, Phase I of the SCF pilot began in June 2014 and successfully settled over 2,000 Medicare Part B appeals. OMHA initiated Phase II in Fall 2015 and expanded the program to include most Part B provider and supplier appeals. Phase III of the program included certain Part A appeals and opened on February 25, 2016. In late 2017, around the same time that CMS announced its Low Volume Appeals Initiative, OMHA announced its plan for SCF expansion, and is currently involved in internal implementation of the program.

The SCF expansion will be an option for Medicare providers or suppliers who have not filed for bankruptcy and do not expect to file for bankruptcy in the future, and who have not had and do not currently have False Claims Act litigation or investigations pending against them or other program integrity issues. For an appeal to be eligible for the expanded SCF program, the appeals must meet several criteria, including the following: 

  • Involve a request for Administrative Law Judge (ALJ) hearing or Council review filed on or before November 3, 2017;
  • Involve a total or 500 or more appeals pending at OMHA and the Council combined, or involve any number of appeals pending at OMHA and the Council that each have more than $9,000 in billed charges;
  • Arise from a Medicare Part A or Part B Qualified Independent Contractor (QIC) reconsideration decision;
  • All pending OMHA and Council appeals associated with the NPI and Provider Transaction Access Number must be included in the SCF;
  • The amount of each claim must be $100,000 or less (or for an extrapolated statistical sample, the overpayment amount extrapolated from the universe of claims must be $100,000 or less);
  • The appeal must not be involved in the OMHA’s Statistical Sampling Initiative; and
  • The appeal must not arise from a QIC or ALJ dismissal order.

A complete listing of the appeal eligibility criteria is posted on the OMHA website with links for registration for the Open Door Call on May 22, 2018, here.


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.

© Arnall Golden Gregory LLP | Attorney Advertising

Written by:

Arnall Golden Gregory LLP

Arnall Golden Gregory LLP on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.


JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at:

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.