Medicare Compliance & Reimbursement

If you rarely need appeals advice, that's a good thing. It means your claims are good-to-go by Medicare standards. But occasional slip-ups do happen, and CMS now offers an option that may expedite your appeals process - for a price.

"As part of the broader Department of Health & Human Services commitment to improving the Medicare appeals process," CMS will offer an additional settlement option for provider and supplier appellants with appeals pending at the Office of Medicare Hearings and Appeals and the Medicare Appeals Council at the Departmental Appeals Board, the agency says on its "Appeals Settlement Initiatives" website

"The low volume appeals settlement option (LVA) will be limited to appellants with a low volume of appeals pending at OMHA and the Council," CMS continues.

Just how low? "Specifically, appellants with fewer than 500 Medicare Part A or Part B claim appeals pending at OMHA and the Council, combined, as of November 3, 2017, with a total billed amount of $9,000 or less per appeal could potentially be eligible, if certain other conditions are met," according to the website. "CMS will settle eligible appeals at 62 percent of the net allowed amount."

Also: "Separately, OMHA will be expanding the Settlement Conference Facilitation Process for certain appellants that are not eligible for the LVA option," CMS adds.