What’s New with the Low Volume Appeals Initiative

TIME SENSITIVE! For even-numbered National Provider Identifiers (NPI): Time is running out for Low Volume Appeals!

Low Volume Appeals Initiative Deadline. This is an important reminder that Thursday, March 9, 2018, is the final day for appellants with National Provider Identifiers (NPIs) ending in an even number (0, 2, 4, 6, 8) to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative.

From March 12, 2018, through April 11, 2018, appellants with NPIs ending in an odd number (1, 3, 5, 7, 9) can submit their expressions of interest. Accordingly, appellants with both odd and even NPIs should submit one EOI per NPI during these designated timeframes.

My agency has not made a decision on the Low Volume Appeals Initiative yet.

Expressing an interest does not commit the agency to the settlement offer agreement, but remember: if you do not submit an Expression of Interest, this opportunity will be lost. Most notably, the timeline from the initial filing of the hearing request until its day in court takes between two and three years. As a result, home health agencies should seriously consider this option to resolve older appeals awaiting Administrative Law Judge (ALJ)  hearings and Medicare Appeals Council (MAC) decisions.

How does my agency determine which claims are eligible for Low Volume Appeals?

Agencies need not identify which claims may be eligible to file an Expression of Interest. Because CMS will do the checking, your agency can review and verify the list before deciding to continue with the settlement option. At QIRT, we are advising agencies to take advantage of this opportunity to recoup 62% of billed amounts on these fully-denied claims.

Updates on the Low Volume Appeals Settlement process.

In other news, on February 28, 2018, CMS updated the FAQ on the LVA process.

For odd-number NPI, on March 13th, 2018, CMS will host a Medicare Learning Network Provider Call to discuss the settlement process, how to identify eligibility, and which of your pending appeals may be settled. Register here for the March 13th call: https://blh.ier.intercall.com/catalog.

For all providers, CMS recently hosted other Medicare Learning Network Provider Calls on the LVA settlement. The written transcripts and audio recordings of those calls are available HERE.

For further information and to obtain the Expression of Interest form, see: https://www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/Appeals-Settlement-Initiatives/Low-Volume-Appeals-Initiative.html

 

 

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