Appeals Demonstration Expanded to Home Health and Hospice

On Jan.1, 2016, the Centers for Medicare & Medicaid Services (CMS) launched the Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration to test whether further engagement between Durable Medical Equipment (DME) suppliers and the DME QIC would improve the understanding of the cause of appeal denials and, over time, result in more proper…

Key Senate Committee Considers Funding for Community-Based Programs

Recently the Senate Appropriations Committee announced legislation funding the departments of Labor, Health and Human Services (HHS), and Education. This legislation outlines discretionary spending limits allowable to HHS as well as recommendations from the Congress on how the money is allocated within agencies and programs. This is an annual process dictating spending levels for the…

HHS Renews Settlement Conference Facilitation for Appeal Resolutions

The Department of Health and Human Services (HHS) has renewed its Settlement Conference Facilitation (SCF) program. The SCF is available to all Medicare Part A and Part B providers and suppliers with appeals pending at the Administrative Law Judge (ALJ) or the Medicare Appeals Council (Council) level. The appeals must have been filed on or…

House Approves Funding for Key Home Health Programs

On Wednesday, September 27th, the House of Representatives approved legislation funding much of the government for Fiscal Year 2019, and moving the deadline for the rest to early December, after the mid-term elections. The legislation, H.R. 6157, was largely the appropriations bill for the Defense, Labor, Health and Human Services, and Education Departments. In total,…

Medicare Appeals Settlement Program Expands

The Office of Medicare Hearings and Appeals (OMHA) announced, during a Medicare Learning Network webcast on May 22, their plans to revise the criteria for the Settlement Conference Facilitation (SCF) program. SCF is an alternative dispute resolution process that gives certain providers and suppliers an opportunity to resolve their eligible Part A and Part B…

HHS Expands Settlement Conference Facilitation Program

The Department of Health & Human Services (HHS) has announced the expansion of the Settlement Conference Facilitation (SCF) program to reach additional providers and suppliers. SCF is an alternative dispute resolution process at Office of Medicare Hearings and Appeals (OMHA) that gives certain providers and suppliers an opportunity to resolve their eligible Part A and…

Low Volume Appeals Initiative Extended into June

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, which meet the eligibility criteria, should submit an EOI between April 12, 2018 and…

CMS Launches New Low Volume Appeals Settlement Option

–Providers encouraged to examine as potential option for appeals resolution As reported previously, the Centers for Medicare & Medicaid Services (CMS) is launching a new Low Volume Appeals (LVA) Initiative to help address the significant backlog of Medicare appeals that are currently in line for resolution.¬† Under the program eligible providers and suppliers may submit…

CMS Hosting Low Volume Appeals Settlement Call Jan. 9

As part of the broader Department of Health & Human Services commitment to improving the Medicare appeals process, the Centers for Medicare & Medicaid Services (CMS) is making 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…