United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2002_register executive 2010-09-23 article Part II Proposed Rules D09002ee1c818a8e1 D09002ee1c818a9d3 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency Under sections 1869 and 1879 of the Social Security Act (the Act), Medicare beneficiaries and, under certain circumstances, providers and suppliers of health care services, may appeal adverse determinations regarding claims for benefits under Medicare Part A and Part B. Section 521 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 amends section 1869 of the Act to substantially revise the Medicare claim appeals process. The statute mandates a series of structural and procedural changes to the existing appeals process, including: The establishment of a uniform process for handling all Medicare Part A and Part B appeals; revised time limits for filing appeals; reduced decision-making time frames throughout all levels of the Medicare administrative appeals system; the introduction of new entities known as qualified independent contractors (QICs) to conduct reconsiderations of contractors' initial determinations or redeterminations; and the establishment of the right to an expedited determination when an individual disagrees with a provider's decision to discharge the individual or terminate services. This proposed rule sets forth the regulations that would be needed to implement the new statutory provisions. 67 FR 69312 https://www.govinfo.gov/app/details/FR-2002-11-15/02-28296 02-28296 fr15no02-27 RIN 0938-AL67 4120-01-P CMS-4004-P https://www.govinfo.gov/app/details/FR-2002-11-15/02-28296 https://www.govinfo.gov/content/pkg/FR-2002-11-15/html/02-28296.htm https://www.govinfo.gov/content/pkg/FR-2002-11-15/pdf/02-28296.pdf 52 p. 69312 69363 67 FR 69312 Title 42 Part 405 42 CFR Part 405 RIN 0938-AL67 Medicare Program: Changes to the Medicare Claims Appeal Procedures; Federal Register Vol. 67, Issue PRORULE 02-28296 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2003-01-14 CMS-4004-P 4120-01-P 02-28296 Proposed rule.

Under sections 1869 and 1879 of the Social Security Act (the Act), Medicare beneficiaries and, under certain circumstances, providers and suppliers of health care services, may appeal adverse determinations regarding claims for benefits under Medicare Part A and Part B. Section 521 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 amends section 1869 of the Act to substantially revise the Medicare claim appeals process. The statute mandates a series of structural and procedural changes to the existing appeals process, including: The establishment of a uniform process for handling all Medicare Part A and Part B appeals; revised time limits for filing appeals; reduced decision-making time frames throughout all levels of the Medicare administrative appeals system; the introduction of new entities known as qualified independent contractors (QICs) to conduct reconsiderations of contractors' initial determinations or redeterminations; and the establishment of the right to an expedited determination when an individual disagrees with a provider's decision to discharge the individual or terminate services. This proposed rule sets forth the regulations that would be needed to implement the new statutory provisions.

We will consider comments if we receive them at the appropriate address, as provided below, no later than 5 p.m. on January 14, 2003. Michele Edmondson (410) 786-6478 (for issues relating to appeal rights). Jennifer Eichhorn (410) 786-9531 (for issues relating to initial determinations and redeterminations). Arrah Tabe (410) 786-7129 (for issues relating to QIC reconsiderations). Jennifer Collins (410) 786-1404 (for issues relating to ALJ hearings and DAB reviews). Rhonda Greene-Bruce (410) 786-7579 (for issues relating to expedited determinations). Medicare: Claims appeal procedures; changes, http://www.access.gpo.gov/nara/index.html Vol. 67, no. 221 Office of the Federal Register, National Archives and Records Administration 2002-11-15 continuing daily deposited born digital 347 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2002-11-15 P0b002ee1809c8623 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr15no02 https://www.govinfo.gov/app/details/FR-2002-11-15 https://www.govinfo.gov/content/pkg/FR-2002-11-15/pdf/FR-2002-11-15.pdf https://www.govinfo.gov/content/pkg/FR-2002-11-15/xml/FR-2002-11-15.xml fdlp 69119 69457 DGPO 2010-09-23 2024-06-07 FR-2002-11-15 machine generated eng FR FR-2002-11-15 67 221