If the injured party or his/her representative disagrees with the amount that CMS has determined for the Medicare Set-aside is there any appeal process?
A47. No. CMS has no formal appeals process for rejection of a proposed Medicare Set-aside amount. However, the injured party or their representative and submitters have several other options available to them.a) An submitting party may always contact the CMS Regional Office that issued the CMS determination for a clarification.b) If there is a belief that a CMS determination contains obvious mistakes, such as mathematical errors, fails to recognize that medical records already submitted, or prices a surgery that has already occurred, then the submitting party may “challenge” the original CMS and request a correction of the errors.c) If there is additional evidence not previously considered by CMS that would warrant a change in the CMS determination, the submitting party “challenge” the original decision and resubmit the case with the additional evidence and request a re-evaluation? It will then be considered a new submission and shall be processed in order of receipt. Although an injur
Related Questions
- Does the injured party have to resubmit the Medicare Set-aside proposal after January 1, 2006 if CMS has already issued a written opinion as to the total Medicare Set-aside amount?
- If the injured party or his/her representative disagrees with the amount that CMS has determined for the Medicare Set-aside is there any appeal process?
- What is the referral process for submission of a proposed Medicare Set-aside to CMS?
