EXTRA Time To Participate in the CMS Low Volume Appeals (LVA) Settlement Initiative.

Low Volume Appeals (LVA) Settlement Initiative, Part 5

What’s New With Low Volume Appeals (LVA) Settlement Initiative?

CMS has extended the deadline to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative to June 8, 2018.

Perhaps prompted by a recent U.S. Court of Appeals ruling, it seems that the Centers for Medicare and Medicaid Services (CMS) is trying to increase participation in the LVA Initiative. The 5th Circuit issued an opinion on March 27, 2018, in Family Rehabilitation, Inc. v. Azar, No. 17-11337 (5th Cir. Mar. 27, 2018) on this matter. The opinion states recoupment of money from a home health agency cannot be initiated until after a hearing has been held by an administrative law judge (ALJ).

After the second level of appeal (reconsideration) decision was issued, there was no way to stop the initiation of recoupment for any identified overpayments of service. Coupled with the extensive wait times for an administrative law judge hearing (a hearing I had this week was requested in September 2014) and the huge backlog of cases at the Office of Medicare Hearings and Appeals (OMHA), it seems that CMS sees this as a way to reduce the multi-year wait times that with the resumption of Recovery Audit Contractor (RAC) activity with become even longer.

So, on 3/29/2018, CMS extended the deadline to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative to June 8, 2018. All appellants (with either an odd or an even NPI) that meet the eligibility criteria may submit an EOI between April 12, 2018, and June 8, 2018. Visit the CMS website (listed below) for details about the process, including a fillable EOI.

Should my agency participate?

This week, agencies with appeals pending have been receiving “Invitation to Submit an Expression of Interest for the Low Volume Appeals Settlement” letters, issued by the CMS Office of Financial Management. These letters further outline general eligibility of claims and give details on the extended period to participate.

As I have noted in prior blogs and discussions with agencies, I strongly recommend home health agency participation in the LVA Settlement.

 

You do not have to determine which claims may be eligible – CMS will do that work for you. You can verify their data, choose to take the settlement, or after seeing which claims are eligible, decline to take the settlement. I recommend that you investigate your options to resolve eligible appeals that have been in process for a long time: a sure 62% return now is better than the uncertainty of winning on appeal and the further time until a hearing is held.

Learn more about LVA

Full details are found at the CMS Low Volume Appeals website:

https://www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/Appeals-Settlement-Initiatives/Low-Volume-Appeals-Initiative.html

 

Expert information provided by:

Joe Osentoski, BAS, RN-BC

QIRT Reimbursement Recovery and Appeals Director

josentoski@QIRT.com

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