New Medicare Appeals Process

The Centers for Medicare & Medicaid Services (CMS) will be implementing a new Medicare claims appeals process effective January 1, 2006.  The current Medicare claims appeals process can take over 1000 days, and the new statutes must reduce that time frame to 300.  In addition, the new rules will establish a uniform appeals process for both Medicare Part A and Part B. The statute will provide new requirements for improved notice of decisions and implement a four-level appeals process. In some cases a party can have their claim escalated to the next level of review if a decision is overly delayed.

The first level of Medicare appeals is now called “redetermination”; CMS has published a Medicare Claims Manual (see R687CP) containing forms for processing this new step of the appeals process.

Comments

[Bobbi Buell]

Hey guys:

Everyone should be reviewing the new rules for claims appeals. This is important stuff.

Bobbi