The DHHS Office of Medicare Hearings and Appeals ("OMHA") recently announced implementation of two new pilot programs in an effort to relieve its backlog of cases awaiting ALJ assignment.

Settlement Conference Facilitation Pilot

Providers and suppliers that filed requests for ALJ hearing in 2013, and are still awaiting assignment of their appeal, now have the option to utilize OMHA's new Settlement Conference Facilitation Pilot program. This program uses mediation principles to assist the appellant and CMS in working toward a mutually agreeable resolution of the claims appealed at the ALJ hearing level.The facilitator is not a fact finder and does not reach any decision on the merits of the case, but, rather, tries to bring the parties together to reach a resolution.  If a resolution is reached, then an agreement is drafted and signed by the parties and the hearing request is dismissed. If a settlement is reached, providers and suppliers could realize some level of payment on the outstanding claims without having to wait the anticipated three years currently expected before receiving an ALJ decision.  If the settlement conference does not lead to a resolution, then the claims are placed back into the ALJ assignment queue.   

Providers and suppliers must meet further requirements in order to qualify for the program. 

Additional information on the Settlement Conference Facilitation Project can be found here: http://www.hhs.gov/omha/settlement_conference_facilitation_pilot.html.

Statistical Sampling

OMHA also announced the Statistical Sampling pilot which is being implemented to provide appellants with an option for addressing large volume claim disputes at the ALJ hearing level.  While this practice has been utilized in the past by specific judges, this is the first time that the program is available on a general level through appellant request.  In order to qualify for this program, the provider/supplier must have requested ALJ hearing during the time period currently being assigned by OMHA Central Operations (currently between April 1, 2013 and June 30, 2013), and there must be a minimum of 250 claims being appealed.

More details on the Statistical Sampling Initiative can be found here:http://www.hhs.gov/omha/settlement_conference_facilitation_pilot.html.