tci Medicare Compliance & Reimbursement - 2006 Issue 1

PHYSICIANS: New Appeals Rules Alter Almost Everything

Physicians must get up to speed before January rolls around.Starting Jan. 1, physicians will have a new appeals process to cope with, according to a recent Medlearn Matters article (MM4019). The basics: Carriers will still perform the first level of appeals--which will now be known as a redetermination--and physicians will have 120 days to request this level of appeal. Physicians will have 180 days to file a request for the next level of appeal, known as a reconsideration, which will be performed by the Qualified Independent Contractor. After that, doctors have 60 days to request the third...

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