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 2005_register executive 2010-09-23 article Part III Rules and Regulations D09002ee1c811d8df D09002ee1c811da1e 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 Medicare beneficiaries and, under certain circumstances, providers and suppliers of health care services, can appeal adverse determinations regarding claims for benefits under Medicare Part A and Part B under sections 1869 and 1879 of the Social Security Act (the Act). Section 521 of the Medicare, Medicaid, and SCHIP Benefits Act of 2000 (BIPA) amended section 1869 of the Act to provide for significant changes to the Medicare claims appeal procedures. This interim final rule responds to comments on the November 15, 2002 proposed rule regarding changes to these appeal procedures, establishes the implementing regulations, and explains how the new procedures will be implemented. It also sets forth provisions that are needed to implement the new statutory requirements enacted in Title IX of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). 70 FR 11420 https://www.govinfo.gov/app/details/FR-2005-03-08/05-4062 05-4062 fr08mr05-14 RIN 0938-AM73 4120-01-P CMS-4064-IFC https://www.govinfo.gov/app/details/FR-2005-03-08/05-4062 https://www.govinfo.gov/content/pkg/FR-2005-03-08/html/05-4062.htm https://www.govinfo.gov/content/pkg/FR-2005-03-08/pdf/05-4062.pdf Claims Freedom of Information Health Facilities Medicare Privacy Administrative Practice and Procedure Health Professions Kidney Diseases Medical Devices Reporting and Recordkeeping Requirements Rural Areas X-Rays 80 p. 11420 11499 70 FR 11420 Title 42 Part 401 42 CFR Part 401 Title 42 Part 405 42 CFR Part 405 RIN 0938-AM73 Medicare Program: Changes to the Medicare Claims Appeal Procedures; Federal Register Vol. 70, Issue RULE 05-4062 III DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2005-05-01 CMS-4064-IFC 4120-01-P 05-4062 Interim final rule with comment period.

Medicare beneficiaries and, under certain circumstances, providers and suppliers of health care services, can appeal adverse determinations regarding claims for benefits under Medicare Part A and Part B under sections 1869 and 1879 of the Social Security Act (the Act). Section 521 of the Medicare, Medicaid, and SCHIP Benefits Act of 2000 (BIPA) amended section 1869 of the Act to provide for significant changes to the Medicare claims appeal procedures. This interim final rule responds to comments on the November 15, 2002 proposed rule regarding changes to these appeal procedures, establishes the implementing regulations, and explains how the new procedures will be implemented. It also sets forth provisions that are needed to implement the new statutory requirements enacted in Title IX of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

Effective date: These regulations are effective on May 1, 2005. However, in view of the wide span of applicability of these rules and the complex, intertwined nature of the affected appeal procedures, not all of these provisions can be implemented simultaneously. Please see section I.E. of the preamble for a full description of the implementation approach. Michele Edmondson-Parrott, (410) 786- 6478 (for issues relating to general appeal rights). Janet Miller, (410) 786-1588 (for issues relating to assignment or authorized representatives). Jennifer Eichhorn Frantz, (410) 786-9531 (for issues relating to initial determinations and redeterminations). Arrah Tabe- Bedward, (410) 786-7129 or Jennifer Eichhorn Frantz, (410) 786-9531 (for issues relating to Qualified Independent Contractor (QIC) reconsiderations). Arrah Tabe-Bedward, (410) 786-7129 or John Scott (410) 786-3636 (for issues relating to expedited access to judicial review, Administrative Law Judge (ALJ) hearings and Medicare Appeals Council (MAC) reviews). Jennifer Collins, (410) 786-1404 or Rosalind Little, (410) 786-6972 (for issues relating to reopenings). Claims Freedom of Information Health Facilities Medicare Privacy Administrative Practice and Procedure Health Professions Kidney Diseases Medical Devices Reporting and Recordkeeping Requirements Rural Areas X-Rays Medicare: Claims appeal procedures; changes, Christopher_Martin@omb.eop.gov PBG937@cms.hhs.gov http://www.access.gpo.gov/nara/index.html http://www.cms.hhs.gov/forms http://www.cms.hhs.gov/medlearn/matters/mmarticles/2004/SE0420.pdf http://www.cms.hhs.gov/regulations/ecomments http://www.cms.hhs.gov/regulations/pra/ http://www.hhs.gov/dab http://www.hhs.gov/medicare/appealsrpt.pdf http://www.Medicare.gov/Basics/forms Vol. 70, no. 44 Office of the Federal Register, National Archives and Records Administration 2005-03-08 continuing daily deposited born digital 433 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2005-03-08 P0b002ee18098b7d4 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr08mr05 https://www.govinfo.gov/app/details/FR-2005-03-08 https://www.govinfo.gov/content/pkg/FR-2005-03-08/pdf/FR-2005-03-08.pdf https://www.govinfo.gov/content/pkg/FR-2005-03-08/xml/FR-2005-03-08.xml fdlp 11109 11529 DGPO 2010-09-23 2024-06-06 FR-2005-03-08 machine generated eng FR FR-2005-03-08 70 44