The landscape of the Medicare appeals process is quickly changing with the launch of the Settlement Conference Facilitation (“SCF”) pilot program. The program is designed to be an alternate dispute resolution process where the appellant and the Centers for Medicare & Medicaid Services (“CMS”) come together to discuss a potential mutually agreeable resolution of claims appealed at the Administrative Law Judge (“ALJ”) level.
The settlement conference facilitator, an employee of the Office of Medicare Hearings and Appeals (“OMHA”), will oversee the process. He or she will not make determinations based on the merits of the claims nor will serve as a fact finder. Rather, the facilitator will use mediation principles to achieve the goal of reaching a mutually agreeable resolution. The facilitator may, however, help the appellant and CMS identify the relative strengths and weaknesses of their respective positions.
In the event a resolution is reached, the settlement facilitator will draft a document, signed by both parties, to reflect the agreement. As part of the agreement, the requests for an ALJ hearing for the claims covered in the settlement will be dismissed.
To determine eligibility for the SCF process, OMHA has provided guidelines available here.
For more information on the Medicare appeals process and other regulatory issues, please contact Abby Pendleton, Esq. or Jessica Gustafson, Esq. at (248) 996-8510 or via email at firstname.lastname@example.org or email@example.com.