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Low Volume Appeals Settlements

Update (January 4, 2018):

Beginning February 5, 2018, CMS will start accepting Expressions of Interest (EOIs) for a limited settlement agreement option for Medicare Fee-For-Service providers, physicians, and suppliers (appellants) with fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals (OMHA) and the Medicare Appeals Council (Council) at the Departmental Appeals Board.  

Specifically, CMS will make available an administrative settlement process for appellants with fewer than 500 appeals pending at OMHA and the Council, combined, as of November 3, 2017, to settle the portion of their pending appeals that have total billed amounts of $9,000 or less per appeal in exchange for timely partial payment of 62% of the net Medicare approved amount.

For more information visit CMS website at http://go.cms.gov/LVA.

Update (December 27, 2017):

On Tuesday, January 9, 2018, from 1:30pm to 2:30pm, CMS will host a National Provider Call (NPC) on the logistics of the low volume appeals settlement process.  Registration details are available here:  https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events.html.  Participants should submit questions in advance of the call to MedicareSettlementFAQs@cms.hhs.gov and include “Low Volume Appeal Settlement Process January NPC” in the subject line.  Questions received in advance may be addressed during the call or referenced in materials following the call.

Initial Announcement (December 3, 2017):

As part of the broader Department of Health & Human Services commitment to improving the Medicare appeals process, CMS will make available an additional settlement option for providers and suppliers (appellants) with appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board.

The low volume appeals settlement option (LVA) will be limited to appellants with a low volume of appeals pending at OMHA and the Council. Specifically, appellants with fewer than 500 Medicare Part A or Part B claim appeals pending at OMHA and the Council, combined, as of November 3, 2017, with a total billed amount of $9,000 or less per appeal could potentially be eligible, if certain other conditions are met. CMS will settle eligible appeals at 62% of the net allowed amount.

Additional information about LVA is available on CMS’s website at:  http://go.cms.gov/LVA.

Separately, OMHA will be expanding the Settlement Conference Facilitation Process for certain appellants that are not eligible for the LVA option.  More information will be available on the OMHA website at https://www.hhs.gov/about/agencies/omha/about/special-initiatives/settlement-conference-facilitation/index.html.

Please continue to monitor these websites for specific details about these options in the coming weeks.

Content created by Departmental Appeals Board (DAB)
Content last reviewed on January 11, 2018