CMS to launch 2 new Medicare appeals settlement options to clear claims backlog

CMS is launching two additional initiatives to help clear the mounting Medicare appeals backlog at the Administrative Law Judge level.

The low-volume appeals settlement option will be limited to those with fewer than 500 Medicare Part A or Part B claim appeals pending with the Office of Medicare Hearings and Appeals and the Medicare Appeals Council as of Nov. 3, with a total billed amount of $9,000 or less per appeal. CMS said it will settle eligible appeals at 62 percent of the net allowed amount.

The Office of Medicare Hearings and Appeals will also be expanding the settlement conference facilitation process for certain appellants that are not eligible for the low-volume appeals option. CMS said more information about this initiative will be available on the OMHA website in coming weeks.

CMS is launching the new settlement options to clear the significant backlog of Medicare appeals that has resulted in a nearly three-year adjudication process for each Medicare claim that is denied. 

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