Medicare Compliance & Reimbursement

Dollars matter the higher in the appeals process you go. Medicare has shaken up its appeals system in the last few years, so make sure you know how to pursue appeals for incorrectly denied claims. Here are the current four levels of appeals as outlined by the HHS Office of Inspector General: LEVEL 1: CONTRACTOR REDETERMINATION At the first level, an appellant may request a redetermination with a Medicare carrier or intermediary within 120 days of receipt of the notice of the initial determination.The redetermination must be made by an individual who was not involved in the initial determination. This individual reviews evidence, including previously submitted evidence and any additional evidence that the parties submit or the individual obtains, to uphold or reject the initial determination. At levels one and two, the appellant may contest a denied claim of any dollar amount. Generally,the contractor must make a redetermination decision within [...]