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Medicare Compliance & Reimbursement

Medicare Regulations:

Distinguish Redetermination From Reconsideration

Published on Tue May 06, 2025

Question: What’s the difference between a redetermination and a reconsideration, in terms of Medicare? Wisconsin Subscriber Answer: “Redetermination” is what the Centers for Medicare & Medicaid Services (CMS) and Medicare Administrative Contractors (MACs) call the first level of appeal for a claim billed to Medicare that has been denied. According to CMS, any party involved on the initial claim [...]
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