CMS Discusses New Low-Volume Appeals Settlement Option

Feb 15, 2018 - 02:27 PM

The Centers for Medicare & Medicaid Services this week held a Medicare Learning Network call on its new settlement option for health care providers with a low volume of appeals pending at the Office of Medicare Hearings and Appeals and Medicare Appeals Council. Announced last November, the settlement option began accepting expressions of interest Feb. 5 from eligible appellants with fewer than 500 Medicare Part A or Part B claim appeals combined as of Nov. 3, 2017, who may opt to settle appeals with total billed amounts of $9,000 or less in exchange for timely partial payment of 62% of the net Medicare approved amount. Participants must settle all eligible appeals. For more information, see the slides from the call. Interested providers may want to assess their eligibility for the settlement and the value for them of participating. CMS first announced the settlement option in its latest court filing in an ongoing lawsuit brought by the AHA and three hospitals to eliminate an appeals backlog at the administrative law judge level. The trial court is now evaluating the agency’s claim that it can’t meet the court-imposed targets for reducing the backlog.

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