Medicare Appeals Settlement Program Expands

Posted on Tuesday, May 29, 2018 7:18 PM

The Office of Medicare Hearing and Appeals (OMHA) announced their plans to revise criteria for the Settlement Conference Facilitation (SCF) program.  SCF is an alternative dispute resolution process that gives providers and suppliers the opportunity to resolve their Part A&B appeals that are pending at the Administrative Law Judge (ALJ) level and Medicare Appeals Council. 

Currently, the SCF addresses providers and supplies with high volume and/or high billed amounts on appeals. Appellants must have 500 or greater appeals waiting at the ALJ/Council or appeals that are at $9,000 or greater in billed amounts. The revised criteria would require appellants have only 25 or more eligible appeals pending or, less than 25 eligible appeals pending and at least one appeal that has more than $9,000 in billed amounts.

The most notable difference between the LVA and SCF programs, outside of the eligibility criteria, is the settlement process. The SCF is a negotiated settlement between CMS and the appellant using a conference facilitator. The LVA settlement is a set 62% of the net Medicare approved amount on the appeals.

It is unknown whether CMS intends to allow the LVA program to expire as scheduled and require all provider and suppliers to work through the SCF process for eligible appeals.

Source: NAHC Report

About Corridor

Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years. Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education . At Corridor, we make the business of caring for people Better! For the most important industry updates and news that impacts home health and hospice, please make sure to sign up for our weekly newsletter to receive the latest up-to-date industry information direct to your inbox!

For additional information, please contact Corridor at 1-866-263-3795.

Go Back

Explore Corridor’s Solutions

Share This Story, Choose Your Platform!