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Medicare Compliance & Reimbursement

APPEALS:

Here's One Appeals Change Providers Should Notice

Published on Sun Mar 27, 2005

Medicare carriers will send appeal denial notes.

Starting in January, when a Medicare carrier rejects a provider's first-level appeal, the carrier will also issue a helpful new notice.

This notice will include specific reasons for the denial and an account of missing information or documentation required for the reconsideration at the Qualified Independent Contractor level, Jennifer Frantz with the Centers for Medicare and Medicaid Services revealed at an April Open Door Forum on the new appeals process. ALJs Get New Responsibilities Other new information from the forum included an update on the role of Administrative Law Judges in the appeals process; ALJs will now review each case de novo. That means that unlike before, providers don't have to submit new evidence to receive an ALJ hearing - and, in fact, providers won't be able to do so under early and full presentation requirements.

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