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CMS changes rules to appeal Medicare payment decisions

The United States Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS) recently announced a change to the appeals process. The changes will impact Medicare beneficiaries, providers and suppliers.

Why the change? The agency proposed the rule in October of 2018. After announcing the proposed rule, the agency reviewed correspondence from 15 commentators. Commentators included representatives of insurance groups, providers, provider advocate groups and beneficiaries.

The agency reports the majority of received comments were in favor of the proposal. As such, the government ultimately passed the proposed rule. The changes go into effect this summer, scheduled to begin July 8, 2019.

What did the CMS change? The agency reports the new rule is designed to help streamline the claims appeals process and increase transparency as well as address technical issues involving inconsistent definitions.

Examples that highlight these goals include:

  • Signature requirements. The CMS used to require appellants to sign an appeal request. The new rule removes this requirement.
  • Vacating dismissals. The new rule also changes the time allowed to vacate a dismissal. The date is currently expressed in months, the new rules changes this to calendar days. The current law provides for six months to vacate, the new law changes this to 180 calendar days.
  • Change Health Insurance Claim Number to Medicare Numbers. This change is one of semantics. It changes the language used in the application from the term Medicare health insurance claim number (HICN) used throughout the appeals application to the term Medicare numbers.

These are just some of the changes that will impact the Medicare payment appeals process in the near future. Those who are impacted are wise to seek legal counsel to discuss their options and better ensure an appeal is in compliance with these new rules.

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