Urology Coding Alert

Question: I heard that Medicare is putting some new rules for appeals in place. Can you explain them to me?

New Jersey Subscriber

Answer: What you heard is correct: CMS now offers an option that may expedite your appeals process - but it comes at 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.

How low is 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.