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 CMS Claims Final Rule Will Streamline Medicare Appeals for Providers

In a final rule published in the Federal Register on May 7, the Centers for Medicare & Medicaid Services (CMS) clarifies changes it has made to the appeals process in the Medicare program for providers, beneficiaries, and suppliers, which the agency believes will benefit stakeholders by streamlining the process.

Titled “Medicare Program; Changes to the Medicare Claims and Medicare Prescription Drug Coverage Determination Appeals Procedures (84 FR 19855),” the rule is effective on July 8.

CMS said the final rule revises regulations for appealing “adverse determinations regarding claims for benefits under Medicare Part A and Part B or determinations for prescription drug coverage under Part D.”

The changes will reduce administrative burden on providers, suppliers, beneficiaries, and appeal adjudicators, CMS said. “These revisions, which include technical corrections, also help to ensure the regulations are clearly arranged and written to give stakeholders a better understanding of the appeals process.”

In response, the long term and post-acute care profession backed the effort. For example, the American Health Care Association (AHCA) said, “AHCA supports efficiencies that facilitate the appeals process, reduce administrative burden, and ensure beneficiaries have access to the appropriate benefits.”

Some of the changes involve removing redundant steps in the appeals process, addressing which entities have to sign an application for an appeal, and condensing the time frame for action, among other measures in the new rule, CMS said.

To read the rule, go to the Federal Register at

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