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CodeMap Compliance Briefing: 01/28/05


 

Editor's Welcome

Last week we discussed the first step in the Medicare Part B appeals process. Today we will continue our discussion by outlining how to proceed if you are not satisfied with the results of the initial redetermination. Please feel free to send any questions regarding this or any other compliance matter. We will try to answer as many inquiries as possible, either directly or as the subject of future CodeMap Compliance Briefings.

Sincerely,

Charles Root, Ph.D.

Second Level of Appeal: Hearing Officer Hearing

If a provider is dissatisfied with the outcome of a redetermination and the difference between the billed amount and the Medicare-allowed amount is $100 or more, the provider, also known as an appellant, may request a Hearing Officer hearing. A Medicare-appointed Hearing Officer will conduct the hearing and determine if the carrier's decision followed guidelines and was appropriate.

The appellant must file a request, in wri....

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