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By Sandra Gauron, Audit and Appeals Coordinator

In an effort to provide Administrative Law Judge (ALJ) backlog relief, CMS launched the Settlement Conference Facilitation (SCF) pilot program in July 2014.  SCF is an alternative dispute resolution process designed to bring the appellant and the Centers for Medicare & Medicaid Services (CMS) together to discuss the potential of a mutually agreeable resolution for Medicare Part A and Part B claims appealed to the Office of Medicare Hearings and Appeals (OMHA) level or the Medicare Appeals Council (Council) level of the Medicare claims appeals process.

On the outset, the requirements set forth were very specific; giving only a limited number of providers the ability to participate.  Based on success with this program, and in order to make a dent in the existing ALJ backlog, the SCF program has been expanded yet again.  The most recent change is to make eligible appeals pending at the ALJ hearing or Council review level filed by the appellant on or before March 31, 2020 for SCF.

For specific eligibility and process instruction, please refer to the following website:  OMHA Settlement Conference Facilitation

Are you interested in pursuing a SCF or want to learn more about the process? Let us help!

The van Halem Group has provided guidance and support for their clients through the appeals process and more recently, through the various appeal alternatives, including SCF. Whether you want first level appeal submission assistance or a representative at your hearing, our combined experience and expertise is available to you. Contact us today for more information!