Is Medicare making changes to the fee-for-service claims appeal process?
Yes. Earlier this year, the Centers for Medicare and Medicaid Services (CMS) outlined major changes to Medicare fee-for-service claims appeal procedures. The changes were required by two recent laws, including the Medicare reform legislation passed in late 2003. Q: When will these changes take place? A: The CMS is phasing in the new appeal procedures, beginning with Medicare Part A. Effective May 1, 2005, Part A fee-for-service claims appeals were subject to the new process. Changes for Part B fee-for-service claims will take effect Jan. 1, 2006. Q: What changes are being made? A: Here is a list of key appeals process changes: • Uniform appeal procedures will be implemented for both Part A and Part B claims. • The decision-making timeframe for administrative appeals will be significantly reduced to 60 days. If Medicare contractors do not respond within that time period, patients or physicians can escalate their appeal to the second level. • Eight qualified independent contractors will
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