title: CMS issues updated rules for the Medicare claims appeal process.
abstract: BIPA requires extensive changes to Medicare's appeal process. However, due to the lack of funding and adequate resources, CMS has been unable to immediately implement many of BIPA's far-reaching changes. CMS is committed to making a transition to the new process as quickly as possible and intends to implement as many key issues as feasible within budget and resource limits. Once Congress allocates funds for the new changes, CMS will be in a better position to implement all aspects of BIPA. [table: see text] The most significant change that BIPA presents is that Congress will require 12 new contractors to handle Part A and Part B appeals. These entities will be known as qualified independent contractors (QICs). CMS has completed development of the requests for proposals needed to solicit bids for the QIC contracts, including full statements of the scope of work (SOW) for these contracts. CMS released the draft SOW on Oct. 7, 2002. It is anticipated that the addition of the QICs will provide a more uniform and consistent handling of Medicare appeals on a national level.
authors.affiliation: Lash Group Healthcare Consultants, Charlotte, N.C., USA.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Davidson
mesh_terms: D003284:Contract Services / Q000191:economics / Q000331:legislation & jurisprudence; D017408:Guidelines as Topic; D006801:Humans; D007345:Insurance Claim Review / Q000191:economics* / Q000331:legislation & jurisprudence; D008484:Medicaid / Q000191:economics* / Q000331:legislation & jurisprudence; D006278:Medicare / Q000191:economics* / Q000331:legislation & jurisprudence; D009398:Nephrology / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States