CMS unveils new claims appeal rules
Rehab Regs, March 10, 2005
CMS issued a new streamlined process last week for Medicare beneficiaries, providers, and suppliers to appeal claims denials. The interim final regulations, which were published in this week's Federal Register and become effective May 1, implement provisions for the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act, and the Medicare Prescription Drug Improvement and Modernization Act. The changes include establishment of a uniform process for processing Medicare Part A appeals, reduced decision-making time throughout the appeals process, and use of the new Qualified Independent Contractors to conduct expedited second-level appeals, according to PT Bulletin Online. The new appeals process for Medicare Part B carrier determinations will begin January 1, 2006.
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