Home health agencies and other providers with a low volume of pending appeals at the administrative law judge (ALJ) level now have a new option available to them to get out of the massive appeals backlog.
 
The Low Volume Appeals (LVA) option is available to “providers and suppliers with a low volume of Medicare Part A and B claim appeals pending” at the third and fourth levels of appeal, according to HHS.
 
Appellants will qualify if they have fewer than 500 appeals pending at the third and fourth levels of appeal combined as of Nov. 3, 2017, with a total amount of $9,000 or less per appeal, HHS says.
 
CMS will settle eligible appeals at 62% of the net allowed amount, according to HHS.
 
Although this might be beneficial for many agencies, attorney Andrew Wachler said he’s hoping more details about the program will come soon — including whether CMS will decide on a case-by-case basis whether providers can participate.
 
In addition, HHS has announced that it’s expanding the Settlement Conference Facilitation program to give more providers and suppliers a chance to resolve pending appeals.
 
In the coming weeks, HHS plans to post additional details about the expansion.
 
Wachler, an attorney with Wachler & Associates in Royal Oak, Mich., hopes providers with more recent claims filed at the ALJ level will be eligible to participate. Right now Part A providers only can participate if their request for an ALJ hearing was filed on or before Dec. 31, 2015.
 
Related link: Check for updates on the LVA option at http://go.cms.gov/2geW3DL.