How is the Amount in Controversy (AIC) calculated?
The amount in controversy is calculated in the following manner: 1. Amount Charged – Unmet Deductible = Subtotal Balance 2. Subtotal Balance – Amount Allowed = Balance 3. Balance x 80% = Amount in Controversy Example: Amount Charged: $500 Unmet deductible: – 50 ____________________________________ Subtotal Balance: $450 Amount Allowed: – 150 ____________________________________ Balance: $300 x 0.80 ____________________________________ Remaining Amount in Controversy: $240 This example satisfies the current Amount in Controversy (AIC) requirement. In 2010, the AIC must be $130 or more for an ALJ hearing at Level 3 of the Medicare appeals process.
