VIA HFMA: ANOTHER CMS SETTLEMENT OFFER COMING IN APRIL WILL APPLY TO CLAIMS FROM $9,000 TO $100,000.
Feb. 6—A new settlement offer to resolve outstanding Medicare claims that have been denied on appeal is available for a limited time from the Centers for Medicare & Medicaid Services (CMS). The offer guarantees 62 cents on the dollar for claimed payment and payable on a faster timetable than previously available.
Hospitals and other providers seeking to resolve pending Medicare appeals first must meet tight eligibility standards, according to a CMS summary.
In November, CMS introduced the Low Volume Appeals Settlement Option (LVASO), which took effect Feb. 5. The initiative aimed at clear a huge backlog of Medicare Part A and Part B only claims. To qualify, hospitals, physicians, and other narrowly defined providers must have fewer than 500 already-denied appeals claims pending either before the Office of Medicare Hearings and Appeals (OMHA, the third stage of the Medicare appeals process) or the Medical Appeals Council (the fourth appeals level) as of Nov. 3, 2017, with no appeals seeking more than $9,000 in individual claim amounts.
In 2014, the American Hospital Association (AHA) and three hospitals filed a lawsuit against CMS to force it to reduce the Medicare appeals backlog at the Administrative Law Judge (ALJ) level, alleging that CMS was violating the Medicare Act that set a 90-day limit for appeal resolution.
While CMS agreed the delays were excessive, it pointed out that ALJ workloads had dramatically increased and would require more funding to cut the backlog. A U.S. district court judge in Washington, D.C., ordered CMS to clear the backlog by 2021. CMS appealed, protesting the timetable would be impossible to achieve. The U.S. Court of Appeals for Washington issued a decision agreeing with CMS, but remanded the case back to the district court.
Assessing the Option
Matthew Fischer, a former CMS attorney now in private practice in Delray Beach, Fla., said qualifying hospitals will get 62 percent return on their claims quickly, “as opposed to waiting, perhaps for years, for an appeals decision that could potentially give even less.”