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>
Related Products
-
Core Skills for Hospital Case Managers:
A guide to fundamental case management responsibilities, Core Skills for Hospital Case Managers serves as a training...
-
Combat RAC Denials: Strategies for Successful Appeals
During this 90-minute audio conference, our speakers provide step-by-step procedures, timelines, tools, and best practices...
-
The 2013 Medicare Compliance Forum: Las Vegas, NV
-
Level of Care Determinations for 2014: Las Vegas, NV
Attend the half-day seminar, Outpatient, Observation or Inpatient? Continuing to Walk the Tightrope of Regulatory Guidance...
-
OPPS and IPPS Reimbursement Fundamentals: Las Vegas, NV
Attend OPPS and IPPS Reimbursement Fundamentals, a half-day seminar on October 2nd in Las Vegas. Learn how CMS’ substantial...
Most Popular
- Articles
-
- Practice the six rights of medication administration
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Skills of effective case managers
- OB services: Coding inside and outside of the package
- Q&A: Primary, principal, and secondary diagnoses
- Ensuring clear and concise documentation critical for case managers
- Neurological checks for head injuries
- The consequences of an incomplete medical record
- Implications of CMS Changes to H&P Requirements
- E-mailed
-
- Medical record committee protocol
- Q&A: Should we report injections during cataract surgery?
- Q&A: Coding for sepsis when other conditions are present
- MRSA in homecare: What is MRSA and how can it be prevented?
- Insider's scoop | Proper coding for depression
- HIPAA Q&A: You've got questions. We've got answers!
- Guidance for proper use of Category III CPT codes
- Get to the heart of cardiac catheterization coding
- Coding tip: Learn types and names of bunion procedures, part 2 of 2
- CMS and AMA documentation guidelines for E/M codes don't always agree
- Searched
