Medicare Appeals: CMS RULE CREATES NEW APPEAL TOOL

Article Overview

This article covers a CMS final rule published in the Federal Register that implements part of BIPA and establishes procedures for Medicare beneficiaries and other aggrieved parties to seek review of national and local coverage determinations. It also contrasts the new review process with existing reconsideration procedures, explains the roles of the Departmental Appeals Board and administrative law judges, and notes timing and implementation concerns raised by CMS and the GAO. The article is relevant to Medicare billing professionals, compliance staff, appeals personnel, and others who track coverage policy and administrative review.