The Office of Medicare Hearings and Appeals (OMHA) has announced an expansion of the Settlement Conference Facilitation (SCF) program available to the appellant community as of June 7, 2019. Previously, the option of an SCF was only available to appeals filed on or before November 3, 2017.
An SCF is “an alternative dispute resolution process designed to bring the appellant and the Centers for Medicare and Medicaid Services (CMS) together to discuss the potential of a mutually agreeable resolution for Medicare Part and Part B claims.” Claims that are eligible for SCF must be at the OMHA level or the Medicare Appeals Council (MAC) level.
An employee of OMHA is designated as a facilitator for the duration of an SCF, whose main purpose is to facilitate payment negotiations between the appellant and OMHA, working to make the two parties see the relative strengths and weaknesses of their positions. The facilitator does not act as a fact finder during this process, nor do they make determinations on the qualities of the claims.