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News & Insights

CMS expands appeals settlement options to reduce backlog

Washington Connection

Government Programs

CMS expands appeals settlement options to reduce backlog

CMS announced a limited low-volume appeals (LVA) settlement option for certain Medicare Part A and B appeals pending with the Office of Medicare Hearing and Appeals and Appeals Council.  Eligible providers are those with fewer than 500 pending appeals that have billed amounts of $9,000 or less per appeal. CMS would settle eligible appeals at 62% of the net approved amount. To begin the process, providers must complete and submit an expression of interest form by June 8. Visit CMS’ LVA webpage for more information. 

MGMA Government Affairs prepared resources to help members stay current on Medicare’s various audit programs and better understand the process for appealing a claims denial or payment recoupment. Find these member-benefit resources and more on our Audits & Appeals landing page