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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.

 

IRS Responds - Economic Impact Payments Do Not Belong to Nursing Homes or Care Facilities

In response to the concerns that some nursing homes and care facilities have been taking patients economic impact payments (“EIP”) and claiming the EIP belongs to the facility, the IRS issued a reminder that the EIP does not belong to a nursing home or care facility even if that facility receives the individual’s payments, either directly or indirectly. The EIP does not count as income or a resource in determining an individual’s eligibility for Medicaid or other federal programs for a period of 12 months from when the EIP is received. What this means: an individual’s EIP does not have to be turned over by the benefit recipient.

Title VII to Protect LGBTQ Community

It is not every day that the United States Supreme Court issues a decision that dramatically changes the workplace, but it happened this week. In a landmark decision captioned as Bostock v. Clayton County, issued by the Court on June 15th, the Court ruled that federal law prohibiting discrimination on the basis of “sex” will now include protections for individuals on the basis of sexual orientation, transgender, and gender identity.

Update: President Trump Signs Paycheck Protection Program Flexibility Act of 2020

On June 3, 2020, Congress updated the CARES Act by passing the Paycheck Protection Program Flexibility Act of 2020 (“FA”). The legislation, which has not yet been signed into law by President Trump, would provide more flexibility to small businesses who received loans under the Paycheck Protection Program (“PPP”).

Workers’ Compensation Claims and COVID-19

Can one of my employees file a workers’ compensation claim if they claim that they contracted coronavirus at work? We get that question a lot. Yes, they can, but you should oppose any application for coverage if you receive one. Generally, the claim will not be granted unless the employee has a job that poses a special hazard or risk of exposure to the virus and the employee can prove that he or she contracted the virus at work.

Ohio State Dental Board Implements Teledentistry Rules

Ohio law defines “teledentistry” as the delivery of dental services through the use of synchronous, real-time communication and the delivery of services of a dental hygienist or expanded function dental auxiliary pursuant to a dentist’s authorization.[1] The law requires a dentist who desires to provide dental services through teledentistry to apply for a teledentistry permit from the Ohio State Dental Board (“OSDB”).[2] Pursuant to the mandate under Ohio Revised Code 4715.436, the OSDB is implementing the following teledentistry permit rules and requirements (to be set forth under Ohio Administrative Code Chapter 4715-23). These regulations, which were subject of a public hearing on February 19, 2020, are effective on May 30, 2020.