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.

 

Florida’s “Stay-at-Home” Order and What it Means for Businesses

On April 1, 2020, in response to the State’s ongoing efforts to fight the spread of COVID-19, Governor Ron DeSantis issued Executive Order 20-91, which is State-wide “Stay-at-Home” Order. The Order goes into effect Friday, April 3, 2020 at 12:01 a.m., and expires on April 30, 2020, unless extended by subsequent order (the full text of the order is available here).

CMS Offers New Stark Waivers and More Flexibility to Health Care Providers Due to COVID-19

On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued several temporary regulatory waivers to further enable the American healthcare system to respond to the COVID-19 pandemic with more efficiency and flexibility. The official publication can be found here: Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19.

#CancelRent – What’s Next for Landlords?

Across the country, residential tenants, small businesses, and even national retailers such as Cheesecake Factory, Subway, and Mattress Firm have declared war on their landlords by refusing to pay rent on account of the Covid-19 pandemic (“COVID-19”). This has sent shockwaves through the real-estate industry. As of April 1st, residential tenants owe an estimated $40 Billion in rent. Estimates for the commercial sector are not far off. So far, federal, state, and local measures have focused on providing relief to residential and commercial tenants and even to some commercial landlords.

Record Keeping Requirements to Receive FFCRA IRS Tax Credit

On April 1, 2020, the IRS and Department of Labor issued temporary regulations to provide clarity regarding the documents required by employees requesting leave under the Families First Coronavirus Response Act (FFCRA) and the documentation that employers need to maintain.

Eviction & Foreclosure During the COVID-19 Pandemic

Like most areas of our society, the COVID-19 pandemic has greatly impacted the business relationships between landlords and tenants and between lenders and borrowers. In most states, non-essential retailers and other businesses have closed their doors and are doing business online, to the extent that they can. Some businesses, like The Cheesecake Factory, have announced that they would not be paying rent at any of their locations for at least a month due to the pandemic. Landlords and homeowners are concerned about being able to pay their mortgages and tenants are concerned about being able paying their rent.