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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