Appeals Revisions
This change request makes several changes to the manual in accordance with the 42 Code of Federal Regulations (CFR), Parts 401 and 405 Medicare program, changes to the Medicare Claims Appeals Procedures; Interim Final Rule (IFR). We updated the Glossary and made changes to several sections in order to be consistent with the IFR (i.e., removed physician as it is now defined as a supplier). CMS updated the amount that must remain in controversy to file a level 2 and level 5 appeal and clarified the requirements with regards to overpayment cases that involve multiple beneficiaries. Additionally, CMS is providing instructions on how to handle misrouted requests for appeals, as well as paid claim appeals.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 02, 2009
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