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Medicare Appeals Settlement Program Expands

Posted on Tuesday, May 29, 2018 7:18 PM

The Office of Medicare Hearing and Appeals (OMHA) announced their plans to revise criteria for the Settlement Conference Facilitation (SCF) program.  SCF is an alternative dispute resolution process that gives providers and suppliers the opportunity to resolve their Part A&B appeals that are pending at the Administrative Law Judge (ALJ) level and Medicare Appeals Council. 

Currently, the SCF addresses providers and supplies with high volume and/or high billed amounts on appeals. Appellants must have 500 or greater appeals waiting at the ALJ/Council or appeals that are at $9,000 or greater in billed amounts. The revised criteria would require appellants have only 25 or more eligible appeals pending or, less than 25 eligible appeals pending and at least one appeal that has more than $9,000 in billed amounts.

The most notable difference between the LVA and SCF programs, outside of the eligibility criteria, is the settlement process. The SCF is a negotiated settlement between CMS and the appellant using a conference facilitator. The LVA settlement is a set 62% of the net Medicare approved amount on the appeals.

It is unknown whether CMS intends to allow the LVA program to expire as scheduled and require all provider and suppliers to work through the SCF process for eligible appeals.

Source: NAHC Report

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