Medicare Appeals Process Brochure Revised

The Centers for Medicare & Medicaid Services (CMS) has revised for 2011 “The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and other Suppliers” brochure. This brochure provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians, and other suppliers who provide services and supplies to Medicare beneficiaries.

Changes for 2011 include the following:

  • When requesting a redetermination, contractors can no longer correct minor errors and omissions on claims through the appeals process.
  • The amount in controversy threshold for a third-level appeal administrative law judge hearing is $130.
  • The amount in controversy threshold for a fifth-level appeal judicial review in U.S. district court is $1,300.

The revised brochure is now available in downloadable format from the Medicare Learning Network® website.


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