Medicare Low Volume Appeals Initiative Deadline Approaching
In an effort to clear the backlog of Medicare appeals, the Centers for Medicare and Medicaid Services (CMS) has created an administrative agreement process to allow eligible Appellants to withdraw their pending appeals at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (Council) in exchange for partial payment. The process allows for settlement of the outstanding appeal in exchange for timely payment of 62 percent of the net approved amount of the appeal. Medicare Part A providers and Medicare Part B suppliers may be eligible if they have fewer than 500 appeals pending at the specified levels.
Please note that the deadline to file the non-binding Expression of Interest form for providers whose National Provider Identifier (NPI) ends in an even number is Fri., March 9, 2018. Those with NPI numbers ending in odd numbers must file the form between March 12th and April 11, 2018.
Appeals covered by the initiative must meet all of the following elements:
- the appeal was pending before the OMHA and/or Council level of appeal as of Nov. 3, 2017;
- the appeal has a total billed amount of $9,000 or less;
- the appeal was properly and timely filed at the OMHA or Council level as of Nov. 3, 2017;
- the claims included in the appeal were denied by a Medicare contractor and remain in a fully denied status in the Medicare system;
- the claims included in the appeal were submitted for payment under Medicare Part A or Part B;
- the claims included in the appeal were not part of an extrapolation; and
- as of the date this Agreement is fully executed, the appeal was still pending at the OMHA or Council level of review.
The Appellant may not choose to settle some appeals and continue to appeal others; all eligible appeals and associated claims must be settled.
A PowerPoint presentation outlining the initiative is available here, and a set of Frequently Asked Questions posted on Feb. 28th is here. On March 13, 2018, CMS will host a Medicare Learning Network Provider Call to discuss the settlement process, how to identify whether you are eligible, and which of your pending appeals may be settled. Registration for the March 13th call can be found here.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841