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Medicare News
MEDICARE BENEFICIARIES WILL SOON BE ABLE TO RESOLVE MEDICARE APPEALS FASTERCenters for Medicare & Medicaid Services Administrator Mark B. McClellan, M.D., Ph.D., today announced a key step in helping Medicare beneficiaries resolve their appeals more quickly and efficiently, as part of a comprehensive overhaul of the Medicare claims appeals system. CMS awarded contracts to eight Qualified Independent Contractors (QICs) to perform reconsiderations, or second level claims appeals, of denied Medicare fee-for-service claims. “Seniors and people with disabilities deserve a prompt and consistent and responsive process for their claims appeals in Medicare,” said Dr. McClellan. “We are working toward completing our overhaul of the Medicare claims appeals system by October 1, 2005 to better serve Medicare beneficiaries, providers, physicians, and other health care providers.” The reconsiderations that will be conducted by the new QICs will replace the current “fair hearing” process for Medicare Part B claims and establish a new second level of appeal for Medicare Part A claims. Statute requires that reconsiderations must be completed within 60 days from the day the request is filed. The eight entities selected were:
As part of the new process, these contractors will be able to bid on specific types of appeals workloads such as Part A, Part B or durable medical equipment, and in the specific areas of the country for which they will process claims. Other steps that CMS is taking as part of its comprehensive overhaul of Medicare claims appeals include:
Issuing the final regulations needed to implement the new uniform appeals procedures, including the rules QICs and other appeals entities by the end of the year. # # #
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Centers for Medicare & Medicaid Services
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