tci Medicare Compliance & Reimbursement - 2023 Issue Q4

Reader Question: Know This Detail on Redeterminations

Question: We are getting really close to the 120-day deadline to submit a redetermination to Medicare for a claim decision we disagree with. Is there any wiggle room on that deadline or can we ask for an extension? Texas Subscriber Answer: So, you are correct that the Centers for Medicare & Medicaid Services (CMS) gives providers filing a redetermination — the first level of the Medicare appeals process — 120 days from the date of the initial determination notice to submit a request. However, “CMS allows a grace period of an additional five days beyond the time limit...

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