October 14, 2015

Developing Story: OMHA Expands Settlement Conference Facilitation Pilot

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EDITOR’S NOTE: The Office of Medicare Hearings and Appeals (OMHA) is scheduled to conduct an open door teleconference today in Washington to discuss the program expansion. Miserez is expected to listen to the proceedings. 

The Office of Medicare Hearings and Appeals (OMHA) recently announced the expansion of its Settlement Conference Facilitation (“SCF”) pilot program. 

Phase I of the SCF program was originally launched in July 2014 to provide an alternative dispute resolution process for eligible Medicare providers to enter into open and non-binding settlement discussions with the Centers for Medicare & Medicaid Services (“CMS”) with the goal of reaching a mutually agreeable resolution for claims pending at the at the Administrative Law Judge (“ALJ”) level of the Medicare appeals process. 

Under Phase I, the participation in the SCF pilot was limited to claims meeting the narrow eligibility requirements (e.g., Part B claims in which the request for ALJ hearing was submitted in 2013).

The expansion of the SCF program will comprise of two phases (phase II and III).  Phase II of the SCF program, which opened on October 1, 2015, expanded the eligibility requirements for Part B claim appeals to include claims in which the request for ALJ hearing was filed by September 30, 2015, among other expanded eligibility criteria.  Phase II also introduced a new SCF request process. 

Phase III, which is expected to open in 2016, will further expand the pilot to include certain Part A claim appeals.

In addition to the recent announcement, OMHA will hold an Open Door Telephone Conference today to discuss the SCF program expansion and answer related questions from the appellant community.

About the Author

Kevin Miserez is an associate at Wachler & Associates, P.C.  Mr. Miserez dedicates a substantial portion of his practice to representing healthcare providers and suppliers in the defense of RAC, Medicare, Medicaid and third party payer audits.

Contact the Author

kmiserez@wachler.com

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