Medicare program; Medicare appeals of individual claims--HCFA. Final rule with comment period.
Under section 1869 of the Social Security Act, Medicare beneficiaries and, under certain circumstances, providers or suppliers of health care services may appeal adverse determinations regarding claims for benefits under Medicare Part A or Part B. This rule expands our regulations to recognize the right of Part B appellants to a hearing before an administrative law judge (ALJ) for claims if at least $500 remains in dispute and the right to judicial review of an adverse ALJ decision if at least $1,000 remains in controversy. Also, this rule codifies in regulations: Limitations on the review by ALJs and the courts of certain national coverage determinations, and the statutory authority for an expedited appeals process under Part A and Part B.
D014487:Centers for Medicare and Medicaid Services, U.S.; D006801:Humans; D007343:Insurance Carriers / Q000331:legislation & jurisprudence; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence*; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D016344:Medicare Part A / Q000331:legislation & jurisprudence*; D016345:Medicare Part B / Q000331:legislation & jurisprudence*; D014481:United States