Additional SCF Opportunities Become Available

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.

If a resolution is reached, the requests for hearing or review for the appeals in question will be dismissed.

The Department of Health and Human Services (HHS) has posted information on their website regarding the eligibility required for both the appellant and the appeal in order to be considered, as well as information on the SCF process.

HHS is encouraging any Medicare Part A and Part B providers or suppliers who have OMHA or MAC appeals pending to read the additional materials provided on the website and familiarize themselves with the eligibility requirements.

For more information regarding OMHA hearings, please contact Jessica L. Gustafson, Esq. or Abby Pendleton, Esq. at (248) 996-8510.