Revenue Cycle

Refresher: Quick reference appeals time limits

Medicare Update for CAHs, December 28, 2011

Time limit for filing an appeal after:
  • Denial of a claim by the MAC. This is an initial determination. 120 days.
  • A demand letter with an overpayment determination from a RAC. This is an appealable revised determination following reopening, 120 days.

Time limit for the issuance of a decision at each of the following levels of appeal:

  • Redetermination by the MAC 60 days <42 CFR § 405.950>
  • Reconsideration by the QIC 60 days <42 CFR §405.970>
  • Administrative Law Judge Decision 90 days <42 CFR § 405.1016>

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