George Breen Quoted in "Medicare Settlement Process Taking on Appeal Backlog"

Time is running out for Medicare Part A and Part B providers to decide whether they want to take advantage of an expedited process for settling several types of pending administrative payment appeals.

The Centers for Medicare & Medicaid Services established the Low Volume Appeals Initiative as a way to try to decrease the backlog clogging the administrative appeals process. Now qualifying providers, physicians, and suppliers have to battle the clock as they decide whether to opt in to the program by its June 8 expression of interest deadline.

The settlement scheme may not be for everybody, even for those providers and those pending appeals that meet eligibility requirements. But the initiative, under which qualified appellants may receive more than half of the money in the short term rather than waiting years for pending appeals to be resolved, may make sense for many eligible providers, attorneys told Bloomberg Law. ...

Eligible providers must now decide whether a quick settlement is a better option than fighting for their full claim. “If we're talking about resolving the matter through mediation or through some set amount resolution, it's a cost-benefit analysis for the entity,” George Breen, an attorney with Epstein Becker Green in Washington, told Bloomberg Law. …

When determining whether to enter the LVA program, the attorneys who talked to Bloomberg Law said that providers need to consider the strengths and the weaknesses of their cases. They also emphasized the importance of considering the possibility of a positive result before an administrative law judge, despite having to wait. “There's a reason why people are pressing to go through the administrative law judge process,” Breen said, “because their success in overturning recoupment efforts increases substantially once you get to that level and we've had cases where clients do far better when you get to that level.”