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Low Volume Appeals Initiative

As part of the broader Department of Health & Human Services commitment to improving the Medicare appeals process, the Centers for Medicare & Medicaid Services (CMS) began accepting expressions of interest for its Low Volume Appeals (LVA) settlement option on February 5, 2018.

Medicare Fee-For-Service providers, physicians, and suppliers (appellants) with fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council at the Departmental Appeals Board (DAB), combined, as of November 3, 2017, with a total billed amount of $9,000 or less per appeal, could potentially be eligible, if certain other conditions are met. 

CMS will settle eligible appeals at 62% of the net allowed amount.

The deadline to submit an expression of interest (EOI) has been extended to June 8, 2018. Appellants with either an odd or an even NPI that meet the eligibility criteria should submit an EOI between April 12, 2018 and June 8, 2018. 

Details about the process, including a fillable EOI, are available on CMS's website at https://www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/Appeals-Settlement-Initiatives/Low-Volume-Appeals-Initiative.html.

Content created by Office of Medicare Hearings and Appeals (OMHA)
Content last reviewed on March 30, 2018