LTC Providers Can Appeal Medicare Claims Decisions Without Administrative Law Judges

CMS has announced that long term care workers will be able to appeal certain Medicare claims decisions without utilizing an administrative judge. The alternative dispute resolution process called Settlement Conference Facilitation would “bring providers and CMS representatives together to negotiate and settle Medicare disputes with the help of a third party.” According to a fact sheet on the pilot program, this “settlement conference facilitator” would be an employee of the Office of Medicare Hearings and Appeals-a separate agency from CMS. Additionally, the facilitator would not make any determinations on the merits of claims at issue and would not serve as a fact finder; but may help the appellant and CMS see the strengths and weaknesses of their positions. The program is meant for Medicare Part B claims appealed to the administrative law judge level where there is currently a huge backlog of claims. At this time, providers cannot use the alternate method to pursue claims appeals under Medicare Part A, C or D, according to the fact sheet.

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One thought on “LTC Providers Can Appeal Medicare Claims Decisions Without Administrative Law Judges

  1. Pingback: Monday Morning Recap | hmsabc

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