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Appeals = Redeterminations - The Medicare Part B Fee-for Service Appeals Process



Thursday, February 04, 2010


All first level appeals will now be called redeterminations. Redeterminations are the new first level of appeal under Section 521 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA).

The Medicare Part B Fee-for-Service Appeals Process

Appeal Level Time Limit For Filing Request Monetary Threshold To Be Met
Review 120 days from date of initial determination None
Hearing Officer (HO) Hearing (Conducted by a contractor HO) 6 months from date of review determination At least $100 remains in controversy
Administrative Law Judge (ALJ) Hearing Filed within 60 days of receipt of HO hearing decision At least $100 remains in controversy
Departmental Appeals Board (DAB) Review Filed within 60 days of receipt of ALJ hearing decision None
Federal Court Review Filed within 60 days of receipt of DAB hearing decision At least $1000 remains in controversy


Medicare
Thursday, February 04, 2010