Tuesday, July 8, 2014

OMHA Announces Alternative Dispute Resolution for Part B Claims

Dianne De La Mare

The Office of Medicare Hearings and Appeals* has just announced a new pilot, Settlement Conference Facilitation, which it hopes will alleviate some of the significant backlog of Medicare Part B claims being appealed to the Administrative Law Judge (ALJ) level. Settlement Conference Facilitation is an alternate dispute resolution process, designed to bring providers and CMS together to negotiate and settle some Medicare Part B disputes (e.g., only those appeals of Medicare Part B Qualified Independent Contractor-QIC disputes) with the help of a settlement conference facilitator.

The facilitator will be an employee of the Office of Medicare Hearings and Appeals (OMHA), who will use mediation principles to help the parties come to a “mutually agreeable resolution.” The facilitator will not make official determinations on the merits of the claims; but instead will help all the parties “see the relative strengths and weaknesses of their positions.” If a resolution can be reached, a settlement document will be drafted to reflect the agreement, and the document will be signed by all the parties. As part of the agreement, any provider requests for an ALJ hearing for the claims covered by the settlement will be dismissed.

To obtain more information and learn about eligibility and the process to request Settlement Conference Facilitation go to the HHS/OMHA web site at http://www.hhs.gov/omha/settlement_conference_facilitation_pilot.html.  For complete information, please read the entire Settlement Conference Facilitation Pilot Fact Sheet and the process flowchart linked to the HHS/OMHA website. 

*Correction on 7/10/14 OMHA announced the new pilot, NOT CMS.

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