CMS has announced that the Office of Medicare Hearings and Appeals (OMHA) will be expanding its current Settlement Conference Facilitation (SCF) program to reach additional providers and suppliers. Medicare Part A and Medicare Part B providers and suppliers who have OMHA or Medicare Appeals Council (Council) appeals pending may be eligible to participate in the expanded SCF process. Continue reading
The Centers for Medicare & Medicaid Services (CMS) is extending the deadline for appellants to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative to June 8, 2018. Appellants with either an odd or an even NPI, that meet the eligibility criteria, should submit an EOI between April 12, 2018 and June 8, 2018. Details about the process, including a fillable EOI, are available here.
On Thursday, February 15th, the American Hospital Association (AHA) and three member hospitals urged the U.S. District Court for the District of Columbia to reinstate its earlier order requiring the Secretary of Health and Human Services to clear the Medicare appeals backlog at the administrative law judge (ALJ) level within five years. The District Court order was rescinded by the Appeals Court in August. In remanding the case, the appeals court left the lower court free to reinstate the same requirement if HHS fails to demonstrate that it is “impossible” to comply with the mandamus order. In yesterday’s brief the AHA urged the court to do just that. “Because the Secretary has not shown it is impossible to clear the backlog—minus, perhaps, some claims with serious program-integrity concerns—within five years, the Court should require him to do so.” Continue reading
On Friday, November 3, 2017 CMS announced that it will make available a new settlement option for eligible providers and suppliers with a low volume of Medicare Part A and B claim appeals pending at OMHA and/or the Medicare Appeals Council. CMS also announced that OMHA will be expanding the Settlement Conference Facilitation Process for certain appellants that are not eligible for the LVA option. Read the full post here.
Citing a decrease in appealed claim decisions and an increase in the acceptance of provider education under the pilot program, CMS has announced that they have decided to expand the Targeted Probe and Educate (TPE) program to all MAC jurisdictions in latter part of 2017. The TPE program grew out of the broad Probe and Educate program initiated by CMS in 2014. The TPE program began as a pilot in one MAC jurisdiction in June 2016 and was expanded to three additional MAC jurisdictions in July 2017. Continue reading