Wednesday, May 30, 2018

CMS Announces Expanded Settlement Conference Facilitation for Medicare Appeals

Lilly Hummel


The Centers for Medicare and Medicaid Services (CMS) has announced that it will be expanding the Settlement Conference Facilitation (SCF) process to address the Medicare appeals backlog. SCF is an alternative dispute resolution process that gives providers an opportunity to resolve their Medicare appeals pending with the Office of Medicare Hearings and Appeals (OMHA) or the Medicare Appeals Council. Notably, unlike other CMS settlement programs, there is not prescribed settlement percentage in SCF. Rather a facilitator uses mediation to assist the provider and CMS work towards a mutually agreeable resolution as to payment. OMHA has published Frequently Asked Questions with more information. The expansion is in the internal implementation phase, and for now CMS suggests providers continue to use existing SCF criteria and processes.

SCF is separate from the Low Volume Appeals Initiative announced in 2017.

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