Resources

Client Alerts, News Articles, Blog Posts, & Multimedia

Everything you need to know about BMD and the industry.

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.

 


Key Healthcare Provisions in Ohio’s 2026–2027 Budget

Ohio’s newly enacted biennial budget (HB 96) for FY 2026–2027 brings sweeping changes for healthcare providers across the state. The law includes new Medicaid eligibility requirements, reporting mandates, funding directives, and social policy provisions. Several vetoes by Governor DeWine also affect healthcare-related initiatives.

Providers Beware: Court Sides with Insurers in No Surprises Act Arbitration

On June 12, 2025, the Fifth Circuit ruled in favor of Aetna and Kaiser in two lawsuits brought by air ambulance providers challenging how insurers calculated payments under the No Surprises Act’s Independent Dispute Resolution process. The court held that unless there is clear evidence of fraud or serious misconduct, IDR decisions will stand, reinforcing the finality of the arbitration process.

Introducing HB 281: Enforcement of Federal Immigration Laws in Ohio Hospitals

House Bill 281, introduced on May 20, 2025, would require Ohio hospitals to allow law enforcement, including federal immigration agents, to enter facilities and enforce immigration laws. The bill mandates that hospitals comply with information requests and adopt formal policies, raising significant concerns about patient privacy and access to care for immigrant communities.

Parental Consent May Soon Be Required for Minor Mental Health Services in Ohio

HB 172 proposes repealing a provision in Ohio law that allows minors age 14 and older to consent to limited outpatient mental health services without parental involvement. The bill would require parental consent for all such care and remove related language from other sections of the Ohio Revised Code.

Community Behavioral Health Providers - Supervisor Pricing Changes Begin July 1 [Corrected Date]

Effective June 16, community behavioral health providers wishing to receive reimbursement at the supervisor rate must add the HP or HT Modifier to fee-for-service (FFS) claims. Find out about the new guidelines.