Medicare Compliance & Reimbursement

You can appeal enrollment denials to an ALJ.

Be prepared for some changes to the appeals system soon.
 
If your contractor revokes your billing privileges or denies you enrollment in Medicare, you can appeal that decision to an administrative law judge (ALJ) within the U.S. Department of Health and Human Services, according to July 14 Transmittal 151. After an ALJ hearing, you may also be entitled to review by the Department Appeals Board (DAB) and a judicial hearing, according to the Centers for Medicare & Medicaid Services (CMS).

You'd have 60 days to request a reconsideration of a decision to revoke your billing privileges, and your physician or "responsible entity" must sign the request, CMS says.

A Hearing Officer (HO) at the contractor will hold an on-the-record hearing on your appeal within 90 days after receiving the request. If you don't agree with the HO's decision, then you can appeal to the ALJ.

Also, CMS says it no longer requires contractors and Part B carriers to send acknowledgement letters when you request an HO hearing.

And contractors no longer have to notify the local Qualified Independent Contractor (QIC) of a hearing's results, according to Transmittal 985, which CMS issued on June 16.