CMS Offers Possible Settlement Option for Providers with Pending Medicare Appeals

By Mathew J. Levy, Esq., Seth A. Nadel, Esq. & Stacey Lipitz Marder, Esq.,
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The Centers for Medicare & Medicaid Services (“CMS”) is currently experiencing a substantial administrative backlog in processing provider-appeals related to pending Medicare claims. Consequently, in response to the high volume of appeals and as a method of managing the administrative burden, CMS has created a prospective settlement option for providers to receive payment on their outstanding claims.

Medicare’s Low Volume Appeals Settlement (“LVA”) is prospectively available to providers and suppliers with a low volume of appeals pending at the Office of Medicare Hearing and Appeals (“OMHA”) and the Medicare Appeals Council at the Departmental Appeals Board (the “Council”). More specifically, the LVA is available to:

  • Part A Medicare Providers
  • Part B Medicare Physicians and Suppliers
  • Durable Medical Equipment Suppliers billing under Part B

Eligible providers or suppliers with fewer than five hundred (500) Medicare Part A or Part B claims pending at OMHA and/or the Council (or both combined), with a total billed amount of $9,000.00 or less per appeal are potentially qualified, based on certain conditions. Under the LVA, if all conditions are met, providers would be entitled to receive 62% of the net approved amount of their outstanding claims in full satisfaction of their appeals.

Please note that appeals concerning repayment demands which came about as part of an extrapolation are not eligible for inclusion in the LVA.

Any provider that wishes to participate in the LVA must submit an Expression of Interest (“EOI”) to CMS no later than June 8, 2018. You may find additional information and instructions here. This website also contains the EOI form, for any interested providers, in the “Downloads” section at the bottom of the web page.

Overall, the LVA could be a valuable opportunity for providers to receive some payment on claims without having to undergo the administrative burden or expenditure of time necessitated by the delayed appeals process.

If you are interested in participating in the LVA, it is vital that you make a timely submission of the EOI. As the June 8th deadline is rapidly approaching, we have already begun submitting EOIs on behalf of numerous interested providers.

Feel free to contact us if you have any additional questions.