January 2018
The Centers for Medicare and Medicaid Services (“CMS”) recently issued guidance that starting Feb. 5, 2018, CMS will begin the process for the Low Volume Appeal (“LVA”) settlement option that CMS had announced on Nov. 3. Settlements will result in payments of 62 percent of the net Medicare amount billed and approved.

In light of the guidance, here are summaries of six important details:
  1. Check your National Provider Identifier (NPI) now to know when your Expression of Interest (EOI) must be submitted.
  2. Submitting an EOI does not bind you to a settlement—a provider may still decline the final administrative agreement.
  3. Claims that settled will be excluded from future review by a MAC or RAC, but not CERT reviews or investigations related to potentially fraudulent claims
  4. The settlement amount is 62% of the net claim approved amount, not necessarily the amount billed.
  5. Claims that included in this settlement will continue to show as “denied” in the applicable CMS database—this may be a key issue for providers seeking secondary payments.
  6. Any interest paid by the appellant after the claim was denied will be refunded, but no interest will be paid for the claim under appeal.

To view the full e-alert, click here.