CMS Extends Low Volume Appeals (LVA) Initiative Deadline

April 2018 ~

CMS has announced the deadline extension for providers planning to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative.

The deadline to submit an expression of interest (EOI) for the LVA Initiative is scheduled for June 8, 2018. Appellants with either an odd or an even National Provider Identifier (NPI) that meet the eligibility criteria should submit an EOI between April 12 and June 8.

Beginning February 5, CMS began accepting EOIs for a limited settlement agreement option for Medicare Fee-For-Service (FFS) providers, physicians, and suppliers (appellants) with fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals (OMHA) and the Medicare Appeals Council (Council) at the Departmental Appeals Board.

CMS is offering eligible appellants to settle the portion of their pending appeals that have total billed amounts of $9,000 or less per appeal in exchange for timely partial payment of 62% of the net Medicare approved amount.

Eligible Appellants:

  • Medicare Part A and Part B providers, physicians, and suppliers with fewer than 500 appeals pending at OMHA andthe Council, combined, and
  • Do not fit into one or more of the categories listed under “ineligible appellants.”

Ineligible Appellants:

  • Beneficiaries, enrollees, their family members, or estates.
  • State Medicaid Agencies.
  • Medicare Advantage Organizations (Medicare Part C).
  • Those that filed for bankruptcy or expect to file for bankruptcy.
  • Certain appellants that have or have had False Claims Act litigation or investigations pending against them, or other program integrity concerns, including pending civil, criminal, or administrative investigations

For full details regarding this extension, see CMS’ Low Volume Appeals Initiative page.

 

 

Source(s): Health Industry Washington Watch; CMS Appeals Settlement Initiatives;

 

 

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