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CLIENT ALERT: Low Volume Appeals Settlement for RAC Appeals

Client Alert

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.

 


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2022 Healthcare Recap and 2023 Healthcare Check-Up

As the country begins to return to a new “normal” following the COVID-19 pandemic, there are many healthcare rules changing on both the federal and state levels as a result. Thus, it is important for healthcare providers and their employers to be aware of these changing rules, and any implications they may have on their practice. Look back on healthcare in 2022 and find a checklist for 2023.

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Real Estate Investors Position for 2023 Opportunities

Real estate investors weathered another year in a post-pandemic world, with the year closing with yet another interest rate increase coupled with both uncertainty and heightened interest carrying into 2023. Just last Wednesday, the Federal Reserve raised its benchmark interest rate 0.50 percentage points, shifting the target range to 4.25% to 4.50%. The new level is the highest the fed funds rate has been since December 2007 and marks the seventh rate hike this year. So what does this mean to investors, brokers, lenders, and others in the real estate world? Read a few perspectives below from stakeholders familiar with our BMD clients and the markets in which they do business.