OMHA Expands Settlement Conference Facilitation (SCF) Program

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.

SCF is an alternative dispute resolution process at OMHA that gives certain providers and suppliers an opportunity to resolve their eligible Part A and Part B appeals.  The SCF process is designed to bring the appellant and the Centers for Medicare & Medicaid Services (CMS) together to discuss the potential of a mutually agreeable resolution for claims appealed to the third level of the Medicare claim appeals process.  If a resolution is reached, a settlement document is drafted by the settlement conference facilitator and the document is signed by the appellant and CMS at the settlement conference session.  As part of the agreement, the request(s) for an ALJ hearing for the claims covered by the settlement will be dismissed.

OMHA has scheduled an open door call on May 22, 2018 to provide information to appellants interested in resolving their appeals through the SCF process. You can register for the call here.  Appellant and appeals eligibility criteria can be found here.