Client Alerts, News Articles & Blog Posts

Everything you need to know about BMD and the industry.

CLIENT ALERT: Low Volume Appeals Settlement for RAC Appeals

In April, the Centers for Medicare & Medicaid Services (“CMS”) issued a new settlement proposal to providers with outstanding appeals at the Office of Medicare Hearings and Appeals (“OMHA”) and the Medicare Appeals Council (“MAC”). Essentially, CMS is offering to pay up to 62% of the claim to the provider for qualifying claims that are currently in the appeal process. Interested providers may submit an Expression of Interest (“EOI”) to CMS by June 8, 2018. Providers should explore this settlement opportunity and submit an EOI to receive an offer of settlement. Providers may decline the offer after the EOI is submitted. Brennan, Manna & Diamond, LLC’s Provider Relations, Audit, and Appeals Unit, a division of its Healthcare Department, is able to assist providers with filing the EOI, analyzing the outstanding claims subject to the settlement, and reviewing the Administrative Agreement that is offered by CMS.

Overview:

The Low Volume Appeals Initiative (“LVA”) is a program conducted by CMS that allows CMS to settle outstanding reimbursement appeals with appellants, such as United Medical and Wulf Clinic, who meet certain requirements. The settlement is for a fixed percentage of payment of 62% of the amount of reimbursement money the appellant is disputing. Participation in the LVA program is completely voluntary, and appellants will not be compelled to proceed to settlement after submitting an EOI. If the appellant ultimately decides to settle, the appellant and CMS enter into a settlement agreement whereby the appellant agrees to accept 62% of the amount being disputed, to be paid within 180 days, in exchange for a release of all claims it may have against CMS for unpaid reimbursement.

Requirements for Eligibility:

Medicare Part A and Part B providers, physicians, and suppliers who are not in bankruptcy or have False Claims Act allegations pending or completed may be eligible for the LVA program. The appellant must have less than 500 appeals pending at OMHA and MAC, combined. The appellant will be eligible for all appeals under Medicare Part A or Part B that are pending before the OMHA or MAC as of November 3, 2017, that are for a billed amount of $9,000 or less per appeal.

LVA Process:

Interested appellants must first fill out an EOI form and submit it to MedicareAppealsSettlement @cms.hhs.gov. The window in which to submit EOIs is from April 12, 2018 until June 8, 2018. If the appellant is approved to participate in the LVA program, CMS will send a spreadsheet to the appellant with a list of eligible appeals along with an Administrative Agreement. The appellant will then analyze the spreadsheet and resolve any discrepancies with CMS over the following 30 days. If all discrepancies are resolved, CMS and the appellant will enter into the Administrative Agreement and resolve all claims up to 62% of their disputed value. At any point up until signing of the Administrative Agreement, the appellant may withdraw from the program and continue with the normal appeals process.

Should you have any questions concerning the Low Volume Appeals Initiative, please contact Amanda L. Waesch, Esq. (alwaesch@bmdllc.com) or Bryan E. Meek, Esq. (bmeek@bmdllc.com), who are attorneys in Brennan, Manna & Diamond’s Provider Relations, Audits, and Appeals Unit, a division of BMD’s Healthcare Department.

 

CLIENT ALERT: Class Action Waivers in Employment Contracts Upheld by Supreme Court

On May 21, 2018, in a 5-4 decision and a major win for employers, the United States Supreme Court upheld the legality of waivers in employment contracts that prohibit employees from grouping claims together in collective or class actions in favor of individual arbitration proceedings. See Epic Sys. Corp. v. Lewis, ___U.S.___ (2018).

CLIENT ALERT: Prohibition on Recoupment Prior to Exhaustion of Administrative Remedies

In April, the Fifth Circuit Court of Appeals, in Family Rehabilitation, Inc. v. Azar No. 17-11337 (5th Cir. 2018), held that district courts are authorized to enjoin the Centers of Medicare & Medicaid Services (“CMS”) and its contractors from recouping alleged overpayments prior to the completion of the administrative appeal process.

CLIENT ALERT: Ohio Managed Care Organization (MCO) Open Enrollment

Open Enrollment started April 30, and will continue through May 25, 2018, for your MCO (Managed Care Organization). Every State Fund Ohio employer can select their MCO for the coming policy year. The MCO is responsible for helping to manage Ohio Workers’ Compensation claim costs. All State Fund employers will begin to receive correspondence urging them to select that particular MCO, or urging them not to make a switch.

Medical Marijuana Rules and You

The Ohio Medical Board has adopted regulations in conjunction with the Ohio Pharmacy Board that would govern physicians who may elect to participate under the Ohio Medical Marijuana statutes.

BMD Obtains Dismissal of ADA Title III Suit Against National Outlet Mall Chain

On January 12, 2018, Brennan, Manna & Diamond obtained the dismissal of an Americans with Disabilities Act (“ADA”) lawsuit filed against Tanger Factory Outlet Centers, Inc. in the U.S. District Court for the Western District of Michigan. The suit, which was brought under Title III of the ADA, alleged that Tanger’s Byron Center, Michigan outlet mall contained barriers to access in violation of the ADA’s accessibility requirements. The plaintiff demanded prospective injunctive relief, including a retrofit of the entire mall, as well as expert witness and attorneys’ fees.