Medicare Compliance & Reimbursement

Here's how to catch up with the new appeals process.

The Centers For Medicare and Medicaid Services is pushing forward with its plan to overhaul the claims appeal system by the end of 2005.

Update: The agency has issued an interim final rule that responds to public comments about changes to the appeal procedures. The rule also explains how the new process will be implemented, CMS said.

Got questions? A better query may be, "Who doesn't have questions?" Providers, suppliers, beneficiary advocacy groups and administrative law judges (ALJs) have vented a variety of concerns to CMS.

Here's a look at some issues the agency addresses in the rule:
   protections for unrepresented beneficiaries
   deadlines for filing appeals and time frames for decision-making
   reconsiderations
   evidentiary requirements
   the role of the ALJs
   dismissals and remands of appeals
  distinctions between reopenings and appeals. The regulations go into effect May 1, 2005.

The catch: CMS says that due to the "wide span of applicability of these rules and the complex, intertwined nature of the affected appeal procedures," not all of the provisions will be implemented at once, so keep your eyes peeled for the dates of upcoming changes.

Comments must be received 60 days after publication in the Federal Register. To view the rule, go to online to www.cms.hhs.gov/appeals/4064IFC.pdf.