tci Medicare Compliance & Reimbursement - 2003 Issue 44

Medicare Appeals: CMS RULE CREATES NEW APPEAL TOOL

A final rule published in the Nov. 7 Federal Register rounds out the arsenal available to Medicare beneficiaries and others to request or appeal local and national coverage determinations. The rule implements portions of Section 522 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000. It lays out procedures for "aggrieved parties" - i.e., beneficiaries "in need of the items or services that are the subject of the coverage determination" - to seek "review" of national and local coverage determinations. An NCD is a determination by the Department of Health and Human Services Secretary...

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