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CMS Finalizes Changes to the Appeals Regulation

Posted on Friday, May 24, 2019 2:09 PM

Earlier this month, CMS issued a final rule that fine-tunes many regulations governing the Medicare appeals process.  “This final rule revises the regulations setting forth the appeals process that Medicare beneficiaries, providers, and suppliers must follow in order to appeal adverse determinations regarding claims for benefits under Medicare Part A and Part B or determinations for prescription drug coverage under Part D. These changes help to streamline the appeals process and reduce administrative burden on providers, suppliers, beneficiaries, and appeal adjudicators. These revisions, which include technical corrections, also help to ensure the regulations are clearly arranged and written to give stakeholders a better understanding of the appeals process.”

The new rule constitutes the following changes:

  • Removal of Requirement That Appellants Sign Appeal Requests
  • Change to Timeframe for Vacating Dismissals to 180 days
  • Technical Correction to Regulations to Change Health Insurance Claim Number (HICN) References to Medicare Numbers
  • Removal of Redundant regulatory Provisions Relating to Medicare Appeals of Payment and Coverage Determinations and Conforming changes
  • Change to Timeframe for Council Referral
  • Technical Correction to Regulation Regarding Duration of Appointed Representative in a Medicare Secondary Payer Recovery Claim
  • Technical Correction to Actions That Are Not Initial Determinations
  • Changes to Enhance Implementation of Rule Streamlining the Medicare Appeals Procedures

Source: NAHC Report

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