Navigating the Five Levels of Appeal in Medicare Parts A and B Claims

The appeal of Medicare Parts A and B (Original Medicare) claims consists of five levels of appeal,1 each level of appeal containing unique timelines and requirements, and in some cases, multiple timelines that run concurrently. Navigating through each of these levels of appeal, which, at the lower levels are primarily handled by CMS contractors, can be fraught with hazards, and if not done properly, could cost you that appeal. The Social Security Act (the Act) established the five levels of appeal for Original Medicare: Redetermination (Level 1); Reconsideration (Level 2); Hearing before an Administrative Law Judge or ALJ (Level 3); Review...

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