The Centers for Medicare & Medicaid Services plans to release in coming weeks details on a new Medicare appeals settlement option for health care providers and suppliers with a low volume of appeals pending at the Department of Health and Human Services’ Office of Medicare Hearings and Appeals and the Medicare Appeals Council at the Departmental Appeals Board. OMHA also plans to expand its settlement conference facilitation process, an alternative dispute resolution process for certain providers and suppliers with eligible Part A and Part B appeals, to certain appellants who are ineligible for the new low-volume settlement option. According to CMS, the low-volume appeals settlement option will be limited to appellants with fewer than 500 Medicare Part A or Part B claim appeals combined as of Nov. 3, with a total billed amount of $9,000 or less per appeal, who meet certain other conditions. CMS plans to settle eligible appeals under this low-volume option at 62% of the net allowed amount. CMS’s announcement about the new and expanded settlement options immediately follows the government’s most recent court filing in a lawsuit brought by the AHA and three hospitals to require the agency to eliminate the Medicare claims appeals backlog pending at the administrative law judge level. The lawsuit is again before the trial court to evaluate the agency’s claim that it is impossible to meet the court’s previously imposed targets for reducing the Medicare appeals backlog.
Special Bulletin on CMS’s Nov. 26 proposed rule aimed at lowering drug prices for beneficiaries enrolled in Medicare Advantage and Part D programs.
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